脑灌注CT成像评价静脉溶栓桥接动脉取栓后血流动力学变化与临床疗效的关系

Valuation of hemodynamics before and after venous thrombolysis bridging arterial thrombolysis by CTP and its relationship with clinical efficacy

目的利用CT灌注成像技术(CTP)评价比较静脉溶栓桥接动脉取栓治疗前后脑血流动力学变化及与临床疗效的关系。方法收集发病12h内急性脑梗死(ACI)患者行头颅MRI筛查,符合静脉溶栓标准且合并颅内大动脉闭塞或严重狭窄的患者73例,按照是否桥接动脉取栓治疗分为两组,A组为单纯静脉溶栓组,B组为静脉溶栓桥接动脉取栓组;术前及术后24h行头颅CTP检查;比较B组患者治疗前后血流灌注的变化,并比较A、B两组患者治疗后灌注各参数的变化及与疗效的关系。结果B组治疗前后的相对脑血流量(rCBF)、相对脑血容量(rCBV)、相对平均通过时间(rMTT)、相对达峰时间(rTTP)存在明显差异(P<0.05);A组与B组治疗后rCBF、rCBV、rMTT、rTTP存在明显差异(P<0.05);A、B两组患者血管再通率比较存在明显差异(P<0.05),症状改善率、转归良好率比较有明显差异(P<0.05)。结论静脉溶栓桥接动脉取栓能显著改善合并颅内大动脉闭塞或严重狭窄脑梗死患者脑血流动力学;CTP能够比较客观准确地评估血流再灌注程度,能够更全面、准确、客观地反映治疗的效果,并指导后续干预治疗。

Objective To evaluate hemodynamics before and after intravenous thrombolytic bridging arterial thrombolysis by CT perfusion(CTP)imaging and its relationship with clinical efficacy.Methods With the emergent brain MRI scaning diagnosed as cerebral infarction within 12 hours of acute stroke symptom onset,73 cases met thecriteria of intravenous thrombolysis and were complicated with intracranial arterial occlusion or severe stenosis.The patients were divided into two groups according to whether they were treated with arterial thrombectomy or not.group A was treated by pure intravenous thrombolytic therapy,and group B was treated by intravenous thrombolytic bridging arterial thrombectomy.CTP of the skull was performed before and 24 hours after thrombolysis;The changes of blood flow perfusion in group B before and after treatment were compared;The changes of perfusion parameters and the relationship of the therapeutic effect between them were also compared in group A and group B.Results RCBF,rCBV,rMTT and rTTP of patients in group B before and after treatment showed significant differences(P<0.05).RCBF,rCBV,rMTT and rTTP between group A and group B were significant differences(P<0.05).Vascular recanalization rate,symptom improvement rate and good return rate between group A and group B were significant differences(P<0.05).Conclusion The cerebral hemodynamics of cerebral infarction patients with intracranial arterial occlusion can be significantly improved by intravenous thrombolysis bridging arterial thrombolysis.CTP can objectively and accurately evaluate the degree of blood flow reperfusion,and it can reflect the effect of treatment more comprehensively,accurately and objectively,and guide the follow-up intervention treatment.