多模式CT"组织窗"指导下醒后脑卒中再灌注治疗的有效性和安全性研究

Reperfusion therapy in wake-up stroke patients under guidance of "tissue-window": an efficacy and safety study

目的与非醒后脑卒中在"时间窗"内接受再灌注治疗患者对比,评估醒后脑卒中患者在多模式CT"组织窗"指导下进行再灌注治疗的有效性和安全性。方法选择苏州大学附属第一医院神经内科自2018年1月至2019年12月收治的235例急性缺血性脑卒中患者。其中非醒后脑卒中患者在"时间窗"指导下选择再灌注治疗方案。醒后脑卒中患者入院后均急诊行多模式CT检查,采用Mistar软件重建CT灌注成像(CTP)图像,判断患者是否存在"组织窗"后选择再灌注治疗方案。比较醒后脑卒中和非醒后脑卒中患者临床资料、预后和安全性指标的差异。结果235例患者中醒后脑卒中45例,非醒后脑卒中190例。与非醒后脑卒中组比较,醒后脑卒中组患者有高血压史者、采用静脉溶栓治疗者所占比例较低,差异均有统计学意义(P<0.05)。采用静脉溶栓治疗的153例患者中,醒后脑卒中23例,非醒后脑卒中130例。醒后脑卒中患者的入院至静脉溶栓时间(DNT)长于非醒后脑卒中患者,差异有统计学意义(P<0.05)。非醒后脑卒中和醒后脑卒中患者的其他临床资料、预后、安全性指标的差异均无统计学意义(P>0.05)。采用直接取栓或桥接取栓治疗的82例患者中,醒后脑卒中22例,非醒后脑卒中60例。非醒后脑卒中和醒后脑卒中患者的临床资料、预后、安全性指标的差异均无统计学意义(P>0.05)。结论与非醒后脑卒中在"时间窗"内接受再灌注治疗相比,醒后脑卒中患者在多模式CT"组织窗"指导下进行再灌注治疗同样是有效且安全的。

Objective To evaluate the efficacy and safety of reperfusion therapy in patients with wake-up stroke(WUS)under the guidance of"tissue-window"by comparing with patients with non-WUS who received reperfusion therapy within"time-window".Methods Two hundred and thirty-five acute ischemic stroke patients admitted to our hospital from January 2018 to December 2019 were enrolled in our study.Patients with non-WUS received reperfusion therapy within"time-window";patients with WUS accepted multimodal CT examination at Emergency right after admission,Mistar software was used to reconstruct CT perfusion imaging(CTP)images,and reperfusion therapy was given to these patients after the judgement of"tissue-window".The differences of clinical data,prognoses,and safety indexes were compared between patients with WUS and non-WUS.Results In these 235 patients,45 patients were with WUS and 190 were with non-WUS.As compared with patients with non-WUS,those with WUS had significantly lower percentages of patients with hypertension history and patients accepted intravenous thrombolysis(P<0.05).In 153 patients accepted intravenous thrombolysis,23 patients were with WUS and 130 were with non-WUS;the time from admission to intravenous thrombolysis in WUS patients was significantly longer than that in non-WUS patients(P<0.05);the clinical data,prognoses,and safety indexes showed no significant differences between these patients with WUS and non-WUS(P>0.05).In 82 patients accepted bridging thrombectomy and direct thrombectomy,22 patients were with WUS and 60 were with non-WUS;the clinical data,prognoses,and safety indexes showed no significant differences between these patients with WUS and non-WUS(P>0.05).Conclusion By comparing with patients with non-WUS who received reperfusion therapy within"time-window",reperfusion therapy is effective and safe for WUS patients under the guidance of multimodal CT"tissue-window".