基于CT平扫的急性缺血性卒中血管内治疗术前影像学评估的研究进展

Research Progress of Preoperative Imaging Evaluation for Endovascular Treatment of Acute Ischemic Stroke Based on Non-contrast Computed Tomography

急性缺血性卒中治疗的关键在于尽早开通阻塞血管,挽救缺血半暗带。DAWN和/或DEFUSE-3试验将急性缺血性卒中血管内治疗的时间窗从6 h延长至24 h,然而资源要求高、高辐射、造影剂引起的肾损伤和较长的检查时间使得多模态影像筛选方案的实际应用有限。越来越多的证据表明,基于CT平扫的影像标准在选择缺血性卒中合并大血管闭塞患者进行血管内治疗可能是安全有效的。本文将根据血管内治疗的时间窗与梗死核心,从早期时间窗、延长时间窗、超时间窗、大梗死核心血管内治疗4个方面对基于CT平扫的急性缺血性卒中血管内治疗术前影像学评估的研究进展进行综述。

The key to treating acute ischemic stroke(AIS)lies in promptly reopening the blocked blood vessels to salvage the ischemic penumbra.The DAWN and/or DEFUSE-3 trials extended the time window for endovascular treatment of AIS from 6 hours to 24 hours.However,high resource requirements,high radiation exposure,contrast-induced nephropathy,and prolonged examination times limit the practical application of multimodal imaging screening protocols.Increasing evidence suggests that non-contrast computed tomography(NCCT)scan-based imaging criteria may be safe and effective in selecting patients with AIS and large vessel occlusion for endovascular treatment(EVT).This article reviews the research progress on preoperative imaging assessment based on NCCT scan for endovascular treatment of acute ischemic stroke,from four aspects:early time window,extended time window,overtime window,and endovascular treatment for large core infarcts.