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2000
Volume 20, Issue 1
  • ISSN: 1573-4056
  • E-ISSN: 1875-6603
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Abstract

Introduction

To explore the feasibility of applying computed tomography perfusion (CTP) imaging-guided mechanical thrombectomy in acute ischemic stroke patients with large vessel occlusion beyond the therapeutic time window.

Methods

The clinical data of acute cerebral infarction patients with large vessel occlusion who were beyond the therapeutic time window and admitted to Handan Central Hospital from January 2021 to March 2022 were retrospectively analyzed. All patients were assessed by the National Institutes of Health Stroke Scale (NIHSS) and were examined by one-stop CTP imaging. The preoperative onset time of the disease was more than 6 h. Fourteen patients underwent magnetic resonance imaging examination at the same time. Fifty-four patients were retrospectively divided into two groups based on the treatment methods: the mechanical thrombectomy group had 21 patients and the conservative treatment group had 33 patients. NIHSS scoring and computed tomography scan were performed before treatment, 6 h, 24 h, 7 days, and 30 days after treatment.

Results

The NIHSS scores of the patients with acute cerebral large vessel occlusion who underwent CTP imaging-guided mechanical thrombectomy at 6 h, 24 h, 7 days, and 30 days after treatment were compared with those of the conventional treatment group. The NIHSS score of the mechanical thrombectomy group was significantly better, and the difference was statistically significant (P < 0.05). In terms of the prognosis rate and expansion rate of infarct core volume, the patients of the mechanical thrombectomy group had a better prognosis, and the difference was statistically significant (P < 0.05). Artificial intelligence-assisted CTP diagnosis can facilitate the automatic evaluation of diseases and enable quick judgments that are independent of radiologists’ evaluation, but it may pose a problem in the determination of infarct core volume (either being too high or too low).

Conclusion

It is of great significance to apply CTP imaging in guiding the mechanical thrombectomy procedure in acute stroke patients with large vessel occlusion who are beyond the therapeutic time window.

© 2024 The Author(s). Published by Bentham Science Publisher. This is an open access article published under CC BY 4.0 https://creativecommons.org/licenses/by/4.0/legalcode
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2024-01-01
2024-11-23
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References

  1. LassalleL. TurcG. TisserandM. CharronS. RocaP. LionS. LegrandL. EdjlaliM. NaggaraO. MederJ.F. MasJ.L. BaronJ.C. OppenheimC. Aspects (alberta stroke program early CT score) assessment of the perfusion-diffusion mismatch.Stroke201647102553255810.1161/STROKEAHA.116.01367627625381
    [Google Scholar]
  2. SchröderJ. ThomallaG. A critical review of alberta stroke program early CT score for evaluation of acute stroke imaging.Front. Neurol.20177724510.3389/fneur.2016.0024528127292
    [Google Scholar]
  3. RazaS.A. BarreiraC.M. RodriguesG.M. FrankelM.R. HaussenD.C. NogueiraR.G. RangarajuS. Prognostic importance of CT aspects and CT perfusion measures of infarction in anterior emergent large vessel occlusions.J Neurointerv Surg201911767067410.1136/neurintsurg‑2018‑014461
    [Google Scholar]
  4. LiuX. SunW. ZhuW. Guidelines for early endovascular interventional diagnosis and treatment of acute ischemic stroke in China 2018.Chin. J. Neurol.2018519683691
    [Google Scholar]
  5. PowersW.J. RabinsteinA.A. AckersonT. AdeoyeO.M. BambakidisN.C. BeckerK. BillerJ. BrownM. DemaerschalkB.M. HohB. JauchE.C. KidwellC.S. Leslie-MazwiT.M. OvbiageleB. ScottP.A. ShethK.N. SoutherlandA.M. SummersD.V. TirschwellD.L. 2018 guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association /American Stroke Association.Stroke2018493e46e11010.1161/STR.000000000000015829367334
    [Google Scholar]
  6. SaverJ.L. GoyalM. BonafeA. DienerH.C. LevyE.I. PereiraV.M. AlbersG.W. CognardC. CohenD.J. HackeW. JansenO. JovinT.G. MattleH.P. NogueiraR.G. SiddiquiA.H. YavagalD.R. DevlinT.G. LopesD.K. ReddyV. de RochemontR.M. JahanR. Solitaire™ with the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke (SWIFT PRIME) trial: Protocol for a randomized, controlled, multicenter study comparing the Solitaire revascularization device with IV tPA with IV tPA alone in acute ischemic stroke.Int. J. Stroke201510343944810.1111/ijs.1245925777831
    [Google Scholar]
  7. GundaB. SiposI. StangR. BöjtiP. DobronyiL. TakácsT. BerényiT. FutácsiB. BarsiP. RudasG. KisB. SzikoraI. BereczkiD. Comparing extended versus standard time window for thrombectomy: Caseload, patient characteristics, treatment rates and outcomes—a prospective single-centre study.Neuroradiology202163460360710.1007/s00234‑020‑02531‑832935174
    [Google Scholar]
  8. LiJ. ZhangJ. XiongJ. Evaluation of cerebral hemodynamics in patients with ischemic cerebrovascular disease by CT perfusion imaging.Chin J. Brain Dis. Rehab.201554235238
    [Google Scholar]
  9. GengY. GuoG. LiuL. Prediction of hemorrhagic transformation in patients with ischemic stroke based on perfusion CT microvascular permeability.Chin. J. Geriatr. Heart, Brain Vessel Dis.2015171212861288
    [Google Scholar]
  10. YangC. ZhangL. ZhangH. Application value of 320-slice CT perfusion imaging of the whole brain in evaluating ischemic cerebrovascular disease.Chin. J. Crit. Care Med.20153512198199
    [Google Scholar]
  11. WangY. Feasibility and value of 128-slice spiral CT perfusion scan of the whole brain and low-dose half-time scan.Chin. J. CT & MRI20181698789
    [Google Scholar]
  12. LiW. ShangW. Analysis of the application value of susceptibility-weighted imaging technology in ischemic cerebrovascular disease.Chin. J. CT & MRI201715113537
    [Google Scholar]
  13. ZhangJ. WangY. ZhangJ. The early CT score of the alberta stroke project on diffusion-weighted imaging in evaluating the prognosis of acute anterior circulation cerebral infarction by intravenous thrombolysis.Chin. J. Cardiovas. Dis.20182016063
    [Google Scholar]
  14. WangM. ZhouJ. WuA. Research progress of intravenous thrombolysis and endovascular treatment of acute ischemic stroke.Chin. J. Neurol.2017505391395
    [Google Scholar]
  15. YangZ. The application of CTP-ASPECTS score in the prognosis judgment of patients with anterior circulation infarction in acute stage.Guangdong Yixue201233912491251
    [Google Scholar]
  16. LiebeskindD.S. JahanR. NogueiraR.G. JovinT.G. LutsepH.L. SaverJ.L. Serial Alberta Stroke Program early CT score from baseline to 24 hours in Solitaire Flow Restoration with the Intention for Thrombectomy study: A novel surrogate end point for revascularization in acute stroke.Stroke201445372372710.1161/STROKEAHA.113.00391424525954
    [Google Scholar]
  17. BerkhemerO.A. FransenP.S.S. BeumerD. van den BergL.A. LingsmaH.F. YooA.J. SchonewilleW.J. VosJ.A. NederkoornP.J. WermerM.J.H. van WalderveenM.A.A. StaalsJ. HofmeijerJ. van OostayenJ.A. Lycklama à NijeholtG.J. BoitenJ. BrouwerP.A. EmmerB.J. de BruijnS.F. van DijkL.C. KappelleL.J. LoR.H. van DijkE.J. de VriesJ. de KortP.L.M. van RooijW.J.J. van den BergJ.S.P. van HasseltB.A.A.M. AerdenL.A.M. DallingaR.J. VisserM.C. BotJ.C.J. VroomenP.C. EshghiO. SchreuderT.H.C.M.L. HeijboerR.J.J. KeizerK. TielbeekA.V. den HertogH.M. GerritsD.G. van den Berg-VosR.M. KarasG.B. SteyerbergE.W. FlachH.Z. MarqueringH.A. SprengersM.E.S. JenniskensS.F.M. BeenenL.F.M. van den BergR. KoudstaalP.J. van ZwamW.H. RoosY.B.W.E.M. van der LugtA. van OostenbruggeR.J. MajoieC.B.L.M. DippelD.W.J. A randomized trial of intraarterial treatment for acute ischemic stroke.N. Engl. J. Med.20153721112010.1056/NEJMoa141158725517348
    [Google Scholar]
  18. SaverJ.L. GoyalM. BonafeA. DienerH.C. LevyE.I. PereiraV.M. AlbersG.W. CognardC. CohenD.J. HackeW. JansenO. JovinT.G. MattleH.P. NogueiraR.G. SiddiquiA.H. YavagalD.R. BaxterB.W. DevlinT.G. LopesD.K. ReddyV.K. du Mesnil de RochemontR. SingerO.C. JahanR. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke.N. Engl. J. Med.2015372242285229510.1056/NEJMoa141506125882376
    [Google Scholar]
  19. MotyerR. KokH.K. AsadiH. O’HareA. BrennanP. PowerS. LoobyS. NicholsonP. WilliamsD. MurphyS. HillM.D. GoyalM. McManusJ. O’BrienP. ThorntonJ. Outcomes of endovascular treatment for acute large-vessel ischaemic stroke more than 6 h after symptom onset.J. Intern. Med.2017282653754510.1111/joim.1268028875550
    [Google Scholar]
  20. MasliasE. NannoniS. RicciardiF. BartoliniB. StramboD. PuccinelliF. HajduS.D. EskandariA. SaliouG. MichelP. Procedural complications during early versus late endovascular treatment in acute stroke: Frequency and clinical impact.Stroke20215231079108210.1161/STROKEAHA.120.03134933467881
    [Google Scholar]
  21. TsivgoulisG. KatsanosA.H. SchellingerP.D. KöhrmannM. CasoV. PalaiodimouL. MagoufisG. ArthurA. FischerU. AlexandrovA.V. Advanced neuroimaging in stroke patient selection for mechanical thrombectomy.Stroke201849123067307010.1161/STROKEAHA.118.02254030571421
    [Google Scholar]
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