摘要
目的评估真实世界症状性颅内动脉粥样硬化性病变(Symptomatic Intracranial Atherosclerotic Disease,s ICAD)患者血管内治疗术前多模式神经影像学筛选现状及其预后。方法回顾性纳入2016年1月-2019年5月就诊于我院的sICAD患者。入组标准满足责任血管为前循环大动脉近端病变、动脉狭窄率≥70%、基线NIHSS评分≤20分、病后2 w内接受标准药物治疗或病后3 m内接受血管内成形术治疗。研究真实世界血管内治疗术前多模式神经影像学技术的使用情况,分析血管内治疗适应证筛查现状与指南间的差距;评估头部DWI联合传统血管影像学筛查的分水岭梗死患者血管内治疗的临床预后;随访入组患者的临床终点事件与安全性结局,并与标准药物治疗患者进行对比。结果本研究所有入组患者均接受了NCCT/DWI/FLAIR等结构影像学及TCD/MRA等血管影像学检查;38例血管内治疗患者中仅5.3%术前接受了ASL/CTP等灌注成像检查。与标准药物治疗组患者相比,血管内治疗组患者6 m与1 y的卒中复发率均明显降低(P=0.045;P=0.011),且两组间颅内出血及全因死亡率无显著差异(P>0.05)。经头部DWI筛选的分水岭区梗死患者中,血管内治疗组1 y卒中复发率较标准药物治疗组明显降低(P=0.035);而非分水岭梗死患者接受两种治疗方法的复发率相似(P>0.05)。结论血管内治疗患者术前脑灌注状态的评估尚不完善;经由头部DWI联合传统血管影像学检查可明确分水岭梗死及局部脑灌注状态,可替代灌注成像作为血管内治疗适应证筛查方法。
Objective To evaluate the status and prognosis of multimodal neuroimaging screening before endovascular therapy in patients with symptomatic intracranial atherosclerotic disease(s ICAD)in the real world.Methods Patients with s ICAD,who were hospitalized in our hospital from January 2016 to May 2019,were enrolled in the study retrospectively.The admission criteria was:proximal lesions of anterior circulation artery,stenosis rate≥70%,baseline NIHSS score≤20,standard medical therapy within 2 weeks after the onset or angioplasty within 3 months after the onset.The application of multimodal neuroimaging technology before endovascular therapy in the real world was studied,the gap between the current situation and the guidelines of endovascular therapy screening was analyzed.The clinical prognosis of DWI combined with traditional angiographic screening in patients with watershed infarction was evaluated.The clinical and safety outcomes of the patients were followed up and compared with those of the patients treated with standard drugs.Results In this study,all patients received structural imaging examinations such as NCCT/DWI/FLAIR and vascular imaging examinations such as TCD/MRA;Only 5.3%of the 38 endovascular patients received perfusion imaging such as ASL or CTP before surgery.Compared with patients in the standard medical therapy group,the recurrence rate of stroke in the endovascular therapy group were significantly reduced at 6 months and 1 year(P=0.045;P=0.011),and there was no significant difference in intracranial hemorrhage and all-cause mortality between the two groups(P>0.05).Among the watershed infarcts selected by DWI,the 1-year recurrence rate in the endovascular therapy group was significantly lower than that in the standard medical treatment group(P=0.035).The recurrence rate of patients with non-watershed infarcts treated with the two methods was similar(P>0.05).Conclusion The preoperative evaluation of cerebral perfusion in patients with endovascular therapy is not optimal;DWI combined with tradi
作者
薛红莲
李文君
张品元
刘俊艳
XUE Honglian;LI Wenjun;ZHANG Pinyuan(Department of Neurology,The Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)
出处
《中风与神经疾病杂志》
CAS
2020年第6期523-526,共4页
Journal of Apoplexy and Nervous Diseases
