Clinical Study on Evaluation of Cerebral Hemodynamics and Prognosis in Patients with AIS-LVO Undergoing Mechanical Thrombectomy Using Head CT Perfusion Parameters
Objective To investigate the cerebral hemodynamic characteristics of patients with acute ischemic stroke due to large vessel occlusion(AIS-LVO)undergoing mechanical thrombectomy using head CT perfusion parameters,and analyze their prognostic value.Methods A total of 82 patients with AIS-LVO who underwent mechanical thrombectomy from April 2020 to March 2023 were selected as the study subjects.The preoperative head CT perfusion imaging manifestations were analyzed.Relative cerebral blood flow(rCBF),relative cerebral blood volume(rCBV),relative time to peak(rTTP)and relative mean transit time(rMTT)in the direct and indirect blood supply areas were compared.The neurological impairment(NIHSS)scores and Barthel index before surgery and at 6 months after surgery were compared.The correlation between preoperative CT perfusion parameters and preoperative NIHSS score and Barthel index was analyzed.The modified Rankin Scale(MRS)was used to evaluate the prognosis.Preoperative CT perfusion parameters of patients with good and poor prognosis were compared.The prognostic value of preoperative CT perfusion parameters was analyzed using the ROC curve.Results Preoperative head CT perfusion showed abnormal perfusion in the infarction area.rCBF and rCBV in the direct blood supply area were lower than those in the indirect blood supply area.rTTP and rMTT were longer than those in the indirect blood supply area(P＜0.05).The NIHSS score at 6 months after surgery was lower than that before surgery,and Barthel index at 6 months after surgery was higher than that before surgery(P＜0.05).Preoperative rCBF and rCBV were negatively correlated with preoperative NIHSS score(r=-0.517,r=-0.439),and positively correlated with preoperative Barthel index(r=0.406,r=0.355).Preoperative rTTP and rMTT were positively correlated with preoperative NIHSS score(r=0.398,r=0.602),and negatively correlated with preoperative Barthel index(r=-0.447,r=-0.518).Six months after surgery,there were 55 patents with good prognosis and 27 patients with poor prognosis.Patients with good prognosis had higher rCBF and rCBV,and shorter rTTP and rMTT compared with those with poor prognosis(P＜0.05).The sensitivity and specificity of the combination of rCBF,rCBV,rTTP and rMTT for prognosis were 89.09％and 85.19％(AUC=0.940,95％Cl:0.892-0.987).Conclusion Head CT perfusion parameters can effectively help to evaluate cerebral hemodynamic changes in patients with AIS-LVO,and provide certain reference for mechanical thrombectomy and long-term prognosis evaluation.
Acute Ischemic Stroke due to Large Vessel OcclusionHead CT PerfusionMechanical ThrombectomyHemodynamicsPrognosis
万方数据
维普
