临床-ASPECTS评分不匹配在急性颈内动脉或大脑中动脉主干闭塞8～14h再通治疗中的探讨

The evaluation of clinical-ASPCTS mismatch in intra-arterial treatment for acute internal carotid artery or middle cerebral artery tunk occlusion within8-14 hours

目的探讨对急性颈内动脉或大脑中动脉主干闭塞8～14h的患者采用临床-Alberta卒中项目早期CT评分(Alberta stroke programme early CT score,ASPECTS)不匹配指导血管内介入再通治疗的可行性。方法将2012年1月～2017年12月确诊的41例急性颈内动脉或大脑中动脉主干闭塞的住院患者分为治疗组(24例)和对照组(17例),行ASPECTS评分、改良的脑梗死溶栓(modified Thrombolysis in Cerebral Infarction,mTICI)分级、侧枝代偿评估及症状性颅内出血(symptomatic intracranial hemorrhage,SICH)风险评估;于入院时和入院治疗后24h、7d分别进行美国国立卫生研究院卒中量表评分(National Institutes of Health stroke Scale,NIHSS),治疗后90d用改良Rankin量表(Modified Rankin Scale,mRS)评定临床预后,采用Logistic回归预测良好临床预后的相关因素。结果与基础NIHSS评分比较,治疗组患者血管再通治疗后24h和7dNIHSS评分呈显著性下降(P<0.05),治疗后24h、7dNIHSS评分治疗组较对照组显著下降(P<0.05);治疗后90d治疗组良好预后较对照组明显改善(P<0.05),治疗组出血转化率较对照组显著下降(P<0.05)。治疗组良好临床预后与临床-ASPECTS不匹配、良好的侧枝代偿等相关。结论对急性颈内动脉或大脑中动脉主干闭塞8～14h的患者采用临床-Alberta卒中项目早期CT评分不匹配结合侧枝代偿、mTICI分级可能有利于筛选时间窗外血管再通受益患者。

Objective To investigate the feasibility of interventional recanalization therapy of clinical-Alberta early in the project CT score（Alberta stroke programme early CT score,ASPCTS）mismatch in acute internal carotid artery or middle cerebral artery tunk occlusion within 8-14 hours.Methods A prospective study was conducted for 24 patients with acute ischemic stroke（AIS）admitted into our hospital with acute internal carotid artery or middle cerebral artery trunk occlusion from January 2012 to May 2015.41 patients were assigned into two groups：the treatment group（n=24）and the control group（n=17）.ASPECTS score,Modified Thrombolysis in Cerebral Infarction（mTICI）scales,compensatory collateral and symptomatic intracranial hemorrhage（SICH）risk assessment were evaluated.The scores of National Institutes of Health stroke Scale（NIHSS）were scored at haseline,1,7 dpost-admission respectively.Modified Rankin Scale（mRS）were scored were scored at 90 th d.The treatment group and the control group were analyzed by Logistic test.Results Compared with baseline NIHSS score,the scores of NIHSS of the treatment group was significantly decreased and was no significant in the control group at 1,7 th d（P〈0.05）.Compared with the control group,the scores of NIHSS of the treatment group was significant at 1,7 th d.Compared with the control group,mRS were significant difference at 90 d（P〈0.05）.Compared with the control group,SICH was significant difference（P〈0.05）.The correlations for good prognosis in the treatment group were strong with clinical-ASPCTS mismatch,good compensatory collateral.Conclusion To AIS patients with acute internal carotid artery or middle cerebral artery trunk occlusion,clinical-ASPCTS mismatch,compensatory collateral assessment and mTICI classification might facilitate theselection of patients who might benefit from thrombelysis beyond the time window.