急诊CT血管成像预测急性颈内动脉闭塞后血管再通的研究

CT angiography in prediction of recanalization after acute internal carotid artery occlusion

目的研究CT血管造影(CTA)源图像得到的急性颈内动脉闭塞后,血栓信号密度与血管再通之间的相关性。方法回顾性分析44例颈内动脉急性闭塞的脑梗死患者。采用CTA源图像测量血栓密度(CD),根据2次TIMI评估的差值定义血管再通与否,分为再通组12例和未再通组32例。采用多因素回归分析,判定血栓密度与血管再通的关系。结果与未再通组比较,再通组北美症状性颈动脉内膜剥脱研究评分和颅内段再通比例明显降低,颅外段再通、CD绝对值明显升高(P<0.05)。CD绝对值是血管再通的独立预测因素(P=0.010);北美症状性颈动脉内膜剥脱研究评分高和颈动脉颅内段闭塞的患者血管不易再通(P=0.032,P=0.042);心房颤动患者颈动脉闭塞后血管容易再通(P=0.011)。结论 CTA源图像测出的血栓密度值与血管再通有相关性。急性颈内动脉闭塞静脉溶栓效果差。

Objective To study the relation between thrombus signal density and recanalization af- ter acute internal carotid artery （AICA） occlusion detected by CT angiography （CTA）. Methods Clinical data about 44 patients with ischemic stroke due to AICA occlusion were retrospectively analyzed. Their thrombus signal density was detected by CTA and recanalization was defined ac cording to the differential value of two TIMI assessments. The patients were divided into recanali- zation group （n=12） and non-recanalization group （n= 32）. Relation between thrombus signal density and recanalization was analyzed by multivariate logistic regression analysis. Results The NASCET score and intracranial recanalization ratio were significantly lower whereas the extracra- nial recanalization ratio and absolute CD value were significantly higher in recanalization group than in non-recanalization group （P〈0.05）. The absolute thrombus signal density value was an indepent predictor for recanalization （P=0. 010）. The high NASCET score was related with the recanalization in AICA occlusion patients （P= 0. 082, P= 0. 042）. Recanalization was easy to oc- cur in atrial fibrillation patients after AICA occlusion （P=0. 011）. Conclusion Thrombus signal density detected by CTA is related with recanalization and cannot show venous thrombolysis.