急性缺血性脑卒中血管成形术（英文）

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1、EmergentRevascularizationForAcuteIschemicStrokeRishiGupta,MDStaff,CerebrovascularCenterTheClevelandClinicFoundationIntroduction-Thereare700,000ischemicstrokes/yearintheU.S.-70%ofpatientswithcerebralocclusions-Since1995,IVt-PAutilizedwithin0-3hourtimewindow1-Ratesofdelivery3-19%atspecializedce

2、ntersvs.1-2%inthecommunity-Othertherapeuticoptionsneededtobenefitlargernumberofpatients1NINDSt-PAstudygroup,NEJM1995,2Hackeetal.Lancet2004Intro(Cont’d)Potentialwaystoincreasepatientsbeingtreated:1)Utilizationofperfusionmismatchtoselectpatientsforthrombolytictherapy2)Endovasculartechniquestoac

3、hieverecanalization:-MechanicalmethodswithoutthrombolysisforlaterstrokesLargeVesselOcclusion-Tonietal.showed25%ofpatientswithacutestrokedeterioratewithin96hours=poorlongtermprognosis5-Furtherevaluationshowedimprovementwaslinkedtoarterialpatencyorpresenceofcollaterals-Interestingly,15-20%ofpat

4、ientshaveadelayindeteriorationlinkedtovesselocclusion+poorcollaterals65Toni,etalStroke1997,6Tonietal.ArchNeurol1995-Physiologybasedimagingstudies:-MRIDWI/PWI-CTPerfusion-PET-XenonCT-MRInotalwaysavailable24hours,lengthystudies-CTperfusioncannotdelineateamountoftissuedamaged-PETimpracticalinacu

5、testroke,buthasledtoquantificationofCBFvaluesQualitativeQuantitative-Theuseofperfusionimaginghasbeenstudiedtoselectpatientsbeyond3hoursforthrombolysisTwotechniquesutilizedtoassessmismatchMRIperfusion/diffusionimaging-difficulttoobtainurgentlyinmanycentersCTperfusionimaging-canbedoneintheERqui

6、cklySemiQuantitativeCBFEstimatesThijsetal.1lookedat12patientswithacutestroke<7hoursEachpatientwasnotedtohave>20%PWI/DWImismatchMRIobtainedat4to7daysafterstroketocomparefinalinfarctvolumetoinitialDWIlesion1ThijsVNetal.Neurology2001ExampleofPWI/DWImismatchandfinalinfarctThisstudydemonstratedtha

7、tpatientswithanincreasedmeantransittimetheDWIlesionexpandedintowhatwasexpectedonPWIAsecondstudybyTongetal.1showedthattheinitialNIHSSatadmissioncorrelatedmorestronglywithPWIandfinalinfarctvolumeonday7asopposedtoinitialDWIlesion1TongDCetal.Neur