急性缺血性腦卒中血管成形術(shù)(英文)-資料下載頁
2024-11-21 06:31本頁面
【正文】 en PROACT II (66% vs. 48%), authors argue because PROACT was MCA only lesions, while MERCI any arterial occlusion The interventionalists graded rates of recanalization in MERCI trial, in PROACT a core lab graded recanalization,Nakano et al., Stroke 2003,MCA angioplasty,Multimodal Endovascular Therapy,Retrospective review of 168 patients over 6 years treated for acute cerebral arterial occlusions1 Purpose was to determine which modality lead to the highest recanalization rates,1 Gupta R et al. Stroke 2005,* p0.045, ** p0.012,Independent predictors of TIMI 2 or 3 flow after endovascular intervention in Acute stroke.,Summary of Tx Modality and Recanalization Rate,Case Example, 45 year old man arrived at our ER 12 hours from symptom onset with left hemiparesis + right gaze preference (NIHSS 11) A CT head with large perfusion deficit + CTA with RICA occlusion MRI brain at 15 hours with infarct in the right insular cortex,,? CBF,? MTT,RICA occlusion,At 24 hours, patient has hemiplegia (NIHSS 16) A repeat MRI performed showing extension of infarct into right posterior temporal and frontal areas,A Xenon CT performed at 28 hours to determine degree of tissue at risk CBF measurements in right hemisphere at 18 cc/100 g/min ? suggesting more tissue at risk,Patient taken to angiography,RICA occluded,,R MCA patent via ACOMM,Collaterals via PCOMM,Microcatheter distal to occlusion,Post stent/plasty shows patent RICA, Xenon CT post stent reveals normal and symmetric CBF’s, MRI post stent shows no further increase in infarct burden,Patient improved to a NIHSS of 10 the next day At 30 day f/u has a NIHSS of 6 with a mRS of 2,Conclusions,Endovascular therapies may have benefit in select patients Utilization of perfusion studies may improve patient selection A better understanding of the treatment modality utilized may reduce complication rat
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