急性缺血性脑卒中血管成形术(英文).pptVIP

Emergent Revascularization For Acute Ischemic StrokeRishi Gupta, MDStaff, Cerebrovascular CenterThe Cleveland Clinic Foundation Introduction-There are 700,000 ischemic strokes/year in the U.S.-70% of patients with cerebral occlusions-Since 1995, IV t-PA utilized within 0-3 hour time window1-Rates of delivery 3-19% at specialized centers vs. 1-2% in the community-Other therapeutic options needed to benefit larger number of patients1NINDS t-PA 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 therapy2) 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, 15-20% of patients have a delay in deterioration linked to vessel occlusion + poor collaterals65 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 valuesQualitativeQuantitative - The use of perfusion imaging has been studied to select patients beyond 3 hours for thrombolysisTwo techniques utilized to assess mismatchMRI perfusion/diffusion imaging - difficult to obtain urgently in many centers CT perfusion imaging - can be done in the ER quicklySemi Quantitative CBF Estimates Thijs et al.1 looked at 12 patients with acute stroke 7 hoursEach patient was noted to have 20% PWI/DWI mismatchMRI obtained at 4 to 7 days after stroke to compare final infarct volume to initial DWI lesion1 Thijs VN et al. Neu