|
|
|
| Evaluation of Safety and Efficacy of CT Perfusion Imaging in Intravenous Thrombolytic Therapy for Acute Ischemic Stroke |
| LI Weilai, LI Lin, LI Yan, et al |
| The 266th Hospital of PLA, Hebei Chengde 067000, China |
|
|
|
|
Abstract Objective: To explore the guiding role of CT perfusion imaging in the safety and efficacy of intravenous thrombolytic therapy for acute ischemic stroke. Methods: 75 patients with acute middle cerebral artery ischemic stroke (6h) admitted in our hospital from October 2016 to December 2017 were selected as the subjects. The CBF ratio of 35 cases underwent CTP examination ranged from 0.20 to 0.35, suggesting reversible ischemia penumbra. The remaining 40 cases were examined by CTP without ischemic penumbra. The two groups were treated with rt-PA thrombolytic therapy. The bleeding conversion rate, mortality rate, NIHSS score and Barthel index score of 24h, 7d, 30d and 90d after thrombolysis in two groups were compared. Results: There were 1 case of hemorrhage conversion within 48 hours after thrombolytic therapy in IP group and 4 cases of hemorrhage conversion within 48 hours after thrombolytic therapy in no IP group,there were significant differences (P<0.05).There were no deaths in IP group after thrombolytic therapy, and there were 1 deaths in 14d after thrombolytic therapy in group IP, no significant difference (P=0.095).NIHSS scores and Barthel index scores after 24h, 7d, 30d and 90d after treatment in CTP group were better to control group and the difference was statistically significant (P<0.05). Conclusion: In the thrombolytic therapy of patients with acute ischemic stroke, according to the results of CTP examination, it is important to predict the risk of secondary hemorrhage after thrombolytic therapy, which is of great significance to the improvement and prognosis of neural function defects.
|
|
|
|
|
|
[1] Parsons M W,Pepper E M,Bateman G A,et al.Identification of the penumbra and infarct core on hyperacute noncontrast and perfusion CT[J].Neurology,2007,68(10):730~736.
[2] Parsons M,Spratt N,Bivard A,et al.A randomized trial of tenecteplase versus alteplase for acute ischemic stroke[J].N Engl Med,2012,366(12):1099~1107.
[3] Klotz E,Koeng M.Perfusion measurements of the brain:using dynamic CT for the quantitative assessment of cerebral ischemia in acute stroke[J].Eur Radiol,1999,30(3):170~184.
[4] del Zoppo GJ,von Kummer R,Hamann GF. Ischaemic damage of brain microvessels: inherent risks for thrombolytic treatment in stroke[J].Neurol Neurosurg Psychiatry,1998,65(1):1~9.
[5] 张卫国.CT灌注成像在老年急性缺血性脑卒中出血性转化的预测分析[J].中国老年学杂志2013,18(33):4417~4419.
[6] 黄丹江,王宏清,王鹏.CT灌注成像在预测急性缺血性脑卒中溶栓治疗后出血转化的应用[J].临床放射学杂志,2014,33(2):166~170.
[7] Acampa M,Camarri S,Lazzerini PE,et al. Increased arterial stiffness is an independent risk factor for hemorrhagic transformation in ischemic stroke undergoing thrombolysis[J]. Int Cardiol,2017,243: 466~470.
[8] Ocek L,Güner D,Uludagi F,et al. Risk Factors for Hemorrhagic Transformation in Patients with Acute Middle Cerebral Artery Infarction[J].Noro Psikiyatr Ars,2015,52: 342~345.
[9] Murray V, Norrving B, Sandercock PA, et al. The molecular basis of thrombolysis and its clinical application in stroke[J]. Intern Med, 2010, 267(2):191~208.
[10] 刘佳琪,杨春晓.缺血性脑卒中侧支循环的研究进展[J].中风与神经疾病杂志,2016,33(7):663~665. |
|
|
|
2018, Vol. 24 
