急性缺血性脑卒中血管成形术（英文）PPT.ppt

Emergent Revascularization For Acute Ischemic Stroke;Introduction;Intro (Cont’d);Large Vessel Occlusion;-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 ;Example of PWI/DWI mismatch and final infarct;This study demonstrated that patients with an increased mean transit time the DWI lesion expanded into what was expected on PWI A second study by Tong et al.1 showed that the initial NIHSS at admission correlated more strongly with PWI and final infarct volume on day 7 as opposed to initial DWI lesion ;Cerebral Blood Flow changes in Acute Ischemic Stroke;ISCHEMIC PENUMBRA; tissue irreversibly damaged beyond a certain time limit it corresponds to CBF values of less than 12 ml/100g/min 4, 5 thrombolytic therapy administered to patients with large amounts of core is associated with an increased risk of symptomatic hemorrhage and malignant cerebral edema 6, 7, 8, 9, 10 4 Baron et. al, Cerebrovasc Dis 2001 , 5 Heiss et al, Stroke 2000, 6 Goldstein et al., Stroke 2000, 7 Ueda et al., J Cereb Blood Flow Metab 1999 , 8 Larue et al., Stroke 2001, 9 Firlik et al., J Neurosurg 1998, Jovin et al., Neurology 2002 ;23 patient with MCA occlusion 6 hour symptom onset and imaged with Xenon CT prior to IA lysis1 5 patients developed parenchymal hematoma post IA-lysis with t-PA 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;% Ipsilateral MCA Territory Core;CT Perfusion;CBF;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 impro