急性缺血性腦卒中血管成形術(英文)(編輯修改稿)
2024-11-21 06:31 本頁面
【文章內容簡介】 prior to IA lysis1 5 patients developed parenchymal hematoma post IAlysis with tPA Univariate modeling found patients with hyperglycemia, higher % core infarct (33%) and low CBF at higher risk of ICH Patients with a mean hemispheric CBF 13 cc/100 g/min were at significantly higher risk of ICH,1 Gupta R, et al Stroke 2006,Xenon CT (Quantitative CBF),% Ipsilateral MCA Territory Core,Mean Ipsilateral MCA CBF (cc/100g/min),Scatterplot of patients in relation to percent of core infarct and mean ipsilateral MCA CBF,CT Perfusion,Retrospective review of 57 patients treated with Intraarterial tPA for MCA occlusion Mean NIHSS = 16 CT Perfusion performed prior to infusion of IA tPA Patients with lower pretreatment Cerebral blood volume found to be at increased risk of intracranial hemorrhage 16 of 19 patient with hemorrhage initial CBV 2.0 mL/100 g,CBF,CBF mL/100g/min,Scatterplot of patients comparing CBF to CBV In patients treated with IA Thrombolysis,These studies did not look at outcomes, but may give thresholds for future studies ? If CBF parameters can replace time of onset for acute stroke therapies Recanalization has been consistently linked with improved outcome, but requires more testing,LIMITATIONS OF INTRAVENOUS TPA,Recanalization rate poor for larger arteries such as ICA or proximal MCA Outcomes for MCA occlusions poor No information regarding site or presence of arterial occlusion Effectiveness beyond 3 hours not established,i.v tPA recanalization at one hour (angiographic data),Del Zoppo et al., Ann Neurol 1993,Intraarterial Options,Chemical thrombolysis Balloon Angioplasty Clot Retrieval Clot Maceration Stents Multimodal (combination chemical +mechanical),Intraarterial (Cont’d),Advantages Maximum delivery of lytic agent Endpoint of clot lysis Not given if spontaneous clot lysis Disadvantages Time necessary to place catheter R
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