在内血管再注射后的神经成像上缺血核心逆转:系统性审查和元分析
Mohammed S Alqahtani1,2, Aser F Alamri1, Ahmed Alkhiri1
1Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
概括
血管内血栓切除术后缺血核心逆转是常见的,发生在17.5%的患者中. 这种被认为是不可逆转损伤的大脑组织恢复的现象与更好的结果有关,并表明早期成像可能会高估心脏病发作的大小.
科学领域:
- 神经学 神经学
- 放射学 放射学是一门学科.
- 心血管医学 心血管医学
背景情况:
- 在急性缺血性中风 (AIS) 中,缺血核心传统上被视为不可逆转的损伤.
- 新出现的证据表明,随访成像时缺血核心的潜在可逆性,特别是在血管内血栓切除术 (EVT) 后.
研究的目的:
- 系统地审查和分析以EVT治疗的AIS患者中缺血核心逆转的患病率,预测因素和结果.
主要方法:
- 一个系统的审查和对报告在EVT后缺血核心逆转的研究的元分析.
- 在 Medline,Embase,Scopus 和 Web of Science 搜索到 2024 年 12 月.
- 包括14项涉及3640名患者的研究,使用随机效应模型进行聚合分析.
主要成果:
- 缺血核心逆转发生在17.5%的患者中,使用MRI (19.9%) 比使用CT (15.9%) 更频繁,24-48小时 (19.1%) 比较晚 (12.3%).
- 预测因素包括更短的成像时间,IV血栓溶解和成功的再通道化 (TICI 2B-3).
- 糖尿病与更低的逆转几率有关,这与更好的功能结果相关 (mRS 0-2).
结论:
- 缺血核心逆转是EVT后的一个显著现象,在很大一部分患者中观察到.
- 早期成像可能会高估AIS的最终心脏病发作体积.
- 识别预测因素和了解核心逆转的结果可以完善治疗策略和预后.
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