【摘要】 目的:建立动态CT血管造影(CTA)评估急性缺血性卒中患者侧支血流的方法,并分析侧支血流与静脉溶栓治疗预后的关系。方法:回顾性分析大脑中动脉M1段或颈内动脉闭塞的22例急性缺血性卒中患者的CT灌注成像,根据动态CTA影像评估侧支血流的范围、速度。用重复度量检验分析不同侧支血流之间美国国立卫生研究院卒中量表(NIHSS)评分的差异,用非参数spearman相关检验分析其与溶栓后3个月改良Rankin量表(mRS)评分的相关性。结果:与侧支血流总体情况差的患者相比,侧支血流总体情况好的患者溶栓后1个月内NIHSS评分更低[(4.7±5.0)与(25.1±15.1)分,P=0.001],再灌注率更高(69%±32%与23%±54%,P=0.044);3个月mRS评分与侧支血流总体情况得分存在显著正相关(r=0.450,P=0.001)。结论:侧支血流好的急性缺血性卒中患者静脉溶栓后临床预后好。应用动态CTA评估侧支血流可用于预测临床预后。更多还原

【Abstract】 Objective: To evaluate the collateral flow of patients with acute ischemic stroke by dynamic CT angiography( CTA) and to analyze the relationship between collateral flow and outcome after intravenous thrombolysis. Methods: We retrospectively analyzed CT perfusion( CTP) imaging of 22 acute ischemic stroke patients with middle cerebral artery( MCA) or internal carotid artery( ICA) occlusion undergoing intravenous thrombolysis,and reconstructed the images for dynamic CTA in the Second Affiliated Hospital,Zhejiang University School of Medicine from June 2009to October 2013. The total extent and flow speed of collateral flow based on dynamic CTA images of these patients were evaluated. The scores of National Institute of Health stroke scale( NIHSS) in different collateral flows were compared with repeated measuring. The nonparametric Spearman ’s rank correlation was used to assess the relationship between collateral flow and modified Rankin scale( mRS) at 3 months after thrombolytic therapy. Results: Compared with the poor collateral flow group,patients with good collateral flow had lower NIHSS at 1 month after thrombolysis( 4. 7 ± 5. 0 vs25. 1 ± 15. 1,P = 0. 001) and higher reperfusion percentage( 69% ± 32% vs 23% ±54%,P = 0. 044). The total condition score of collateral flow was positively correlated with mRS at 3 months after treatment( r = 0. 450,P = 0. 001). Conclusion: Acute ischemic stroke patients with good collateral flow after intravenous thrombolysis have a better outcome. The dynamic CTA can be used to evaluate the collateral flow and to predict clinical outcomes in patients with acute ischemic stroke after thrombolysis therapy.更多还原