岭南现代临床外科2025，Vol.25Issue(5)：318-324,7.DOI:10.3969/j.issn.1009-976X.2025.05.006
CT低灌注强度比值预测急性前循环卒中血管内介入再通治疗的临床预后
CT hypoperfusion intensity ratio before endovascular thrombectomy is associated with clinical prognosis in patients with anterior circulation large vessel occlusion
摘要
Abstract
Objective Parenchymal hematoma(PH)is a severe type of hemorrhagic transformation and is associated with poor outcomes in patients with acute ischemic stroke after endovascular thrombec-tomy treatment.This study explores the relationship between hypoperfusion intensity ratio(HIR)from CT perfusion imaging with postoperative PH and clinical outcomes.Methods We analyzed the clinical and imaging data of patients with acute anterior circulation large vessel occlusion treated with endovascular intervention in our stroke center from December 2020 to December 2022.HIR was calculated as the ratio of severe hypoperfusion area volume(Tmax>10 seconds)to hypoperfusion area volume(Tmax>6 seconds)from head CT perfusion imaging.The type of hemorrhagic transformation after endovascular thrombectomy treatment was determined according to Heidelberg grading criteria.We analyzed the relationship between clinical,and imaging data with postoperative HT and clinical outcomes at discharge.Results Fifty-five patients with acute anterior circulation large vessel occlusion were included in the study.Twenty-one patients(38.2%)developed HT after thrombectomy treatment,including nine with PH.HIR at admission was significantly higher in the PH group than in the non-PH group(0.58 vs.0.33,P=0.010).HIR was significantly higher in the poor clinical outcome group(modified Rankin Scale 3～6 points)than in the good outcome group(0.47 vs.0.25,P<0.001).In addition,atrial fibrillation,NIHSS score at admission,blood glucose,neutrophil-to-platelet ratio,cerebral blood flow<30%,Tmax>10 seconds,and PH after endovascular thrombectomy were significantly associated with poor clinical outcomes.HIR(OR=1132.791,95%CI:7.979～160 828.706,P=0.005)was one ofthe independent factors for poor clinical outcomes.Conclusion HIR at admission is significantly associated with PH after endovascular thrombectomy,and it is an effective imaging marker for poor clinical outcomes after endovascular thrombectomyfor patients with acute anterior circulation large vessel occlusion.关键词
急性缺血性脑卒中/血管内介入治疗/CT灌注成像/低灌注强度比/出血转化Key words
acute ischemic stroke/endovascular treatment/CT perfusion imaging/hypoperfusion intensity ratio/hemorrhagic transformation分类
临床医学引用本文复制引用
阮鑫磊,陈锐,黄中润,项春,陈培生,石忠松..CT低灌注强度比值预测急性前循环卒中血管内介入再通治疗的临床预后[J].岭南现代临床外科,2025,25(5):318-324,7.基金项目
国家自然科学基金(81720108014) （81720108014）
