急性缺血性脑卒中血管成形术.ppt

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急性缺血性脑卒中血管成形术.ppt

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EmergentRevascularizationForAcuteIschemicStrokeRishiGupta,MDStaff,CerebrovascularCenterTheClevelandClinicFoundation

Introduction-Thereare700,000ischemicstrokes/yearintheU.S.-70%ofpatientswithcerebralocclusions-Since1995,IVt-PAutilizedwithin0-3hourtimewindow1-Ratesofdelivery3-19%atspecializedcentersvs.1-2%inthecommunity-Othertherapeuticoptionsneededtobenefitlargernumberofpatients1NINDSt-PAstudygroup,NEJM1995,2Hackeetal.Lancet2004

Intro(Cont’d)Potentialwaystoincreasepatientsbeingtreated:1)Utilizationofperfusionmismatchtoselectpatientsforthrombolytictherapy2)Endovasculartechniquestoachieverecanalization:-Mechanicalmethodswithoutthrombolysisforlaterstrokes

LargeVesselOcclusion-Tonietal.showed25%ofpatientswithacutestrokedeterioratewithin96hours=poorlongtermprognosis5-Furtherevaluationshowedimprovementwaslinkedtoarterialpatencyorpresenceofcollaterals-Interestingly,15-20%ofpatientshaveadelayindeteriorationlinkedtovesselocclusion+poorcollaterals65Toni,etalStroke1997,6Tonietal.ArchNeurol1995

-Physiologybasedimagingstudies: -MRIDWI/PWI -CTPerfusion -PET -XenonCT-MRInotalwaysavailable24hours,lengthystudies-CTperfusioncannotdelineateamountoftissuedamaged-PETimpracticalinacutestroke,buthasledtoquantificationofCBFvaluesQualitativeQuantitative

-Theuseofperfusionimaginghasbeenstudiedtoselectpatientsbeyond3hoursforthrombolysisTwotechniquesutilizedtoassessmismatchMRIperfusion/diffusionimaging-difficulttoobtainurgentlyinmanycentersCTperfusionimaging-canbedoneintheERquicklySemiQuantitativeCBFEstimates

Thijsetal.1lookedat12patientswithacutestroke7hoursEachpatientwasnotedtohave20%PWI/DWImismatchMRIobtainedat4to7daysafterstroketocomparefinalinfarctvolumetoinitialDWIlesion1ThijsVNetal.Neu