急性缺血性腦卒中血管成形術(英文)-wenkub.com
2024-11-21 06:31 本頁面
【正文】 Emergent Revascularization For Acute Ischemic Stroke,Rishi Gupta, MD Staff, Cerebrovascular Center The Cleveland Clinic Foundation,Introduction,There are 700,000 ischemic strokes/year in the U.S. 70% of patients with cerebral occlusions Since 1995, IV tPA utilized within 03 hour time window1 Rates of delivery 319% at specialized centers vs. 12% in the community Other therapeutic options needed to benefit larger number of patients,1NINDS tPA study group, NEJM 1995, 2 Hacke et al. Lancet 2004,Intro (Cont’d),Potential ways to increase patients being treated: 1) Utilization of perfusion mismatch to select patients for thrombolytic therapy 2) Endovascular techniques to achieve recanalization: Mechanical methods without thrombolysis for later strokes,Large Vessel Occlusion,Toni et al. showed 25% of patients with acute stroke deteriorate within 96 hours = poor long term prognosis5 Further evaluation showed improvement was linked to arterial patency or presence of collaterals Interestingly, 1520% of patients have a delay in deterioration linked to vessel occlusion + poor collaterals6,5 Toni, et al Stroke 1997, 6 Toni et al. Arch Neurol 1995,Physiology based imaging studies: MRI DWI/PWI CT Perfusion PET Xenon CT MRI not always available 24 hours, lengthy studies CT perfusion cannot delineate amount of tissue damaged PET impractical in acute stroke, but has led to quantification of CBF values,Qualitative,Quantitative, The use of perfusion imaging has been studied to select patients beyond 3 hours for thrombolysis Two techniques utilized to assess mismatch MRI perfusion/diffusion imaging difficult to obtain urgently in many centers CT perfusion imaging can be done in the ER quickly,Semi Quantitative CBF Estimates,Thijs et al.1 looked at 12 patients with acute stroke 20% PWI/DWI mismatch MRI obtained at 4 to 7 da
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