切换至 "中华医学电子期刊资源库"
高级检索
中华脑血管病杂志(电子版)

中华脑血管病杂志(电子版) ›› 2023, Vol. 17 ›› Issue (02) : 112 -123. doi: 10.11817/j.issn.1673-9248.2023.02.006

临床研究

急性后循环进展性缺血性卒中患者血管内治疗的效果
黎丹丹1, 程峙娟1, 刘旭1, 陈未平1, 殷敏1, 郭华2, 涂江龙1,†()   
  1. 1. 330006　南昌，南昌大学第二附属医院神经内科
    2. 330006　南昌，南昌大学第二附属医院神经外科
  • 收稿日期:2022-08-17 出版日期:2023-04-01
  • 通信作者: 涂江龙
  • 基金资助:
    江西省科技厅重点研发计划-重点项目(20212BBG71012); 江西省科技厅重点研发计划-一般项目(20203BBGL73129)

Effect of endovascular treatment on acute progressive ischemic stroke in posterior circulation

Dandan Li1, Zhijuan Cheng1, Xu Liu1, Weiping Chen1, Min Yin1, Hua Guo2, Jianglong Tu1,†()   

  1. 1. Department of Neurosurgery, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, China; Department of Neurology, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
    2. Department of Neurosurgery, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
  • Received:2022-08-17 Published:2023-04-01
  • Corresponding author: Jianglong Tu
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

黎丹丹, 程峙娟, 刘旭, 陈未平, 殷敏, 郭华, 涂江龙. 急性后循环进展性缺血性卒中患者血管内治疗的效果[J]. 中华脑血管病杂志(电子版), 2023, 17(02): 112-123.

Dandan Li, Zhijuan Cheng, Xu Liu, Weiping Chen, Min Yin, Hua Guo, Jianglong Tu. Effect of endovascular treatment on acute progressive ischemic stroke in posterior circulation[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2023, 17(02): 112-123.

目的

探讨大血管狭窄或闭塞所致的急性后循环进展性缺血性卒中（AISPPC）血管内治疗效果，为AISPPC的治疗方向提供依据。

方法

根据纳入标准和排除标准，纳入2020年5月至2021年12月在南昌大学第二附属医院住院的AISPPC患者34例，其中将进展时予以血管介入+标准药物治疗的患者作为观察组（21例）；予以标准药物，包括阿司匹林+氯吡格雷/替罗非班/阿加曲班治疗的患者作为对照组（13例，其中失访1例）。收集2组术前资料包括年龄、性别、既往史、烟酒史、脑梗死病因、后循环急性脑卒中预后早期CT评分（pcASPECTS）、Bern弥散加权成像（DWI）评分、不同责任血管、影像资料、起病时美国国立卫生研究院卒中量表（NIHSS）评分、进展时NIHSS评分、症状性颅内出血（sICH）发生率和并发症，统计90 d后NIHSS评分、改良Rankin量表（mRS）评分、90 d病死率。

结果

2组患者基线特征，如年龄、性别、既往史、烟酒史、起病及加重时NIHSS评分、脑梗死病因、pcASPECTS得分、Bern DWI评分、不同责任血管之间比较，差异均无统计学意义（P＞0.05）。多元logistic回归和线性回归分析显示：2组调整年龄、性别后，观察组临床结局次要结果中90 d mRS 0~2分占比较对照组更高（76.19% vs 41.67%，P=0.039），90 d mRS评分较对照组更低[1.00（0，2.00）分 vs 4.50（1.75，6.00）分，P=0.032]，差异均有统计学意义。2组患者多元logistic回归分析结果显示：与对照组比较，观察组有更低的病死率，差异有统计学意义（14.29% vs 50.00%，OR=0.17，95%CI：0.03~0.88，P=0.035）。2组患者均随访至90 d，观察组随访21例中，有3例死亡（2例由于加重时NIHSS评分较高，1例由于再灌注损伤出血转化），对照组13例中1例失访（随访14 d时），12例随访患者中，有6例死亡（4例由于加重时NIHSS评分较高，2例死于严重的并发症），对于随访患者预后情况，K-M生存曲线分析显示：随着随访时间的延长，观察组的生存率高于对照组，远期再发脑梗死风险降低，差异有统计学意义（P＜0.05）。

结论

大血管狭窄或闭塞所致的AISPPC患者血管内介入治疗较保守治疗神经功能恢复更好，病死率更低，且不增加sICH风险，延迟开通血管仍有较好的治疗效果，此外还需要进行临床随机试验来评估其有效性。

关键词: 缺血性脑卒中，进展性, 后循环, 血管内治疗
Objective

To investigate the effect of endovascular treatment on acute ischemic stroke progression in posterior circulation (AISPPC) caused by large vessel stenosis or occlusions, and to provide evidence for the treatment strategy of AISPPC.

Methods

According to the inclusion and exclusion criteria, 34 patients with AISPPC hospitalized in the Second Affiliated Hospital of Nanchang University from May 2020 to December 2021 were enrolled. Among them, 21 patients who were given vascular intervention plus standard drug therapy at the duration of progression were included in the observation group. Patients treated with aspirin plus Clopidogrel/Tirofiban/Argatroban were included in the control group (13 patients, one of whom was lost to follow-up). The preoperative data of the two groups were collected, including age, gender, past medical history, history of alcohol and tobacco use, etiology of cerebral infarction, imaging data, and National Institutes of Health stroke scale (NIHSS) score at onset and at exacerbation, incidence and complications of symptomatic intracranial hemorrhage (sICH). NIHSS score, modified Rankin scale (mRS) score, and mortality at 90 days after treatment were analyzed.

Results

There were no significant differences in baseline characteristics between the two groups, such as age, gender, past medical history, history of alcohol and tobacco use, NIHSS score at onset and exacerbation, cause of cerebral infarction, posterior circulation acute stroke prognosis early computed tomography score (pcASPECTS) score, Bern (diffusion weighted imaging, DWI) score, and different responsible vessels (P＞0.05). Multiple logistic regression and linear regression analysis showed that, after adjusting age and gender, the 90-day mRS 0-2 score in the observation group was higher than that in the control group (76.19% vs 41.67%, P=0.039), and the 90-day mRS score was lower than that in the control group [1.00 (0, 2.00) vs 4.50 (1.75, 6.00)]. Multivariate logistic regression analysis showed that compared with the control group, the observation group had lower mortality, and the difference was statistically significant (14.29% vs 50.00%, OR=0.17, 95%CI: 0.03-0.88, P=0.035). Patients in both groups were followed up to 90 days. Among 21 patients in the observation group, 3 died (2 due to higher NIHSS scores during exacerbation and 1 due to bleeding transformation after reperfusion injury). Among 13 patients in the control group, one was lost to follow-up (at 14 days of follow-up), and 6 died (4 due to higher NIHSS scores during exacerbation and 2 patients died of severe complications). For the prognosis of the follow-up patients, K-M survival curve analysis showed that with the extension of follow-up time, the survival rate of the observation group was higher than that of the control group, and the risk of long-term recurrent cerebral infarction was reduced, and the difference was statistically significant (P＜0.05).

Conclusion

Compared with conservative treatment, endovascular interventional therapy for AISPPC patients caused by large vessel stenosis or occlusions has better neurological function recovery and lower mortality, and dosen't increase the risk of sICH. Delayed vascularization still has a good therapeutic effect. In addition, randomized clinical trials are needed to evaluate its effectiveness.

Key words: Progressive ischemic stroke, Posterior circulation, Endovascular treatment
图1 研究对象纳入流程图 注：NIHSS为美国国立卫生研究院卒中量表；mRs为改良的Rankin量表
表1 观察组与对照组术前临床资料比较
临床资料 观察组（21例） 对照组（13例） 统计值 P值
年龄（岁，
x¯
±s）		 57.52±14.66 67.31±6.56 t=3.343 0.067
性别[例（%）] χ2=0.830 0.362
男 16（76.19） 8（61.54）
女 5（23.81） 5（38.46）
既往史[例（%）]
高血压 19（90.48） 13（100.00） χ2=1.315 0.251
糖尿病 8（38.10） 6（46.15） χ2=0.215 0.643
冠心病 3（14.29） 3（23.08） χ2=0.427 0.513
卒中史 6（28.57） 3（23.08） χ2=0.125 0.724
房颤 2（9.52） 3（23.08） χ2=1.176 0.278
吸烟史 6（28.57） 6（46.15） χ2=1.087 0.297
饮酒史 6（28.57） 1（7.69） χ2=2.141 0.143
NIHSS评分[分，M（QR）]
起病时 2（1，5） 2（0，10） Z=1.866 0.182
加重时 11（9，15） 14（8，27） Z=2.439 0.128
脑梗死病因[例（%）] χ2=4.752 0.093
大动脉粥样硬化型 19（90.48） 9（69.23）
心源性栓塞型 1（4.76） 4（30.77）
不明原因或其他型 1（4.76） 0
pcASPECTS评分（分，
x¯
±s）		 6.71±1.59 7.46±1.61 t=1.709 0.194
Bern DWI评分（分，
x¯
±s）		 5.29±2.00 5.15±3.36 t=0.021 0.887
责任血管[例（%）]
VA 14（66.67） 8（61.54） χ2=0.092 0.761
BA 18（85.71） 7（53.85） χ2=4.190 0.057
PCA 8（38.10） 5（38.46） χ2<0.001 0.983
表2 观察组与对照组事件结局主要及次要结果比较
事件结局 观察组（21例） 对照组（12例） 调整前 调整后*
OR/β（95%CI） P值 OR/β值（95%CI） P值
临床结局
主要结果
mRS 0~3分[例（%）] 17（80.95） 6（50.00） 4.25a（0.88~20.44） 0.071 5.35a（0.87~33.01） 0.071c
次要结果
mRS 0~2分[例（%）] 16（76.19） 5（41.67） 4.48a（0.97~20.59） 0.054 6.98a（1.10~44.07） 0.039c
mRS评分[分，M（QR）] 1.00（0，2.00） 4.50（1.75，6.00） -1.86b（-3.45~-0.27） 0.029 -2.15b（-3.99~-0.31） 0.032d
90 d后NIHSS评分[分，M（QR）] 1.00（0，2.00） 2.50（0.50，3.75） -0.61b（-2.72~1.50） 0.576 -0.70b（-2.97~1.56） 0.550d
影像结局
次要结果
mTICI≥2b级[例（%）] 21（100.00） 0 - ＜0.001 - ＜0.001c
图2 2组mRS评分分布情况 注：mRS为改良Rankin评分
表3 不同病情程度下不同处理方式对90 d预后的影响
病情程度 加重时NIHSS≥15分 OR/β（95%CI） P值 加重时NIHSS＜15分 OR/β（95%CI） P值
观察组（6例） 对照组（6例） 观察组（15例） 对照组（6例）
mRS 0~2分[例（%）] 4（66.67） 1（16.67） 10.00a（0.65~154.40） 0.099 12（80.00） 4（66.67） 2.00a（0.24~16.61） 0.521
mRS 0~3分[例（%）] 4（66.67） 1（16.67） 10.00a（0.65~154.40） 0.099 13（86.67） 5（83.33） 1.30a（0.10~17.73） 0.844
mRS评分[分，M(QR)] 1.00（0.25，3.25） - -3.33b（-5.69~-0.98） 0.020 1.00（0.50，2.00） 1.50（0.25，2.75） -0.27b（-2.20~1.66） 0.789
90 d NIHSS 评分[分，M(QR)] 1.00（0，2.00） - -1.80b（-8.99~5.39） 0.649 1.00（0，2.00） 2.00（0，3.00） -0.46b（-2.54~1.62） 0.670
表4 观察组与对照组安全事件及严重不良事件比较[例（%）]
事件 观察组（21例） 对照组（13例） OR值（95%CI） Wald χ2值 P值
安全事件
90 d死亡 3（14.29） 6（50.00）a 0.17（0.03~0.88） 4.445 0.035
症状性颅内出血 1（4.76） 0 - - 0.997
严重不良事件
SAP 9（42.86） 4（30.77） 1.69（0.39~7.27） 0.493 0.483
心力衰竭 1（4.76） 2（15.38） 0.28（0.02~3.39） 1.016 0.314
图3 观察组与对照组K-M生存曲线分析
表5 观察组介入治疗病例
病例编号 性别/年龄（岁） 责任血管 起病时NIHSS评分（分） 加重时NIHSS评分（分） 加重距离起病时间 手术距离起病时间 90 d NIHSS评分（分） mRS评分（分）
1 M/52 VA、BA、PCA 3 13 4 h 6 h 7 3
2 M/72 VA 10 23 6 h 8 h 死亡 6
3 M/51 VA、BA 18 30 5 h 11 h 8 4
4 M/29 BA 4 8 1 d 1 d 0 0
5 M/70 VA、BA、PCA 7 11 1 d 1 d 1 1
6 M/67 VA、BA、PCA 2 15 1 d 1 d 0 1
7 M/62 BA 0 20 1 d 1 d 1 0
8 M/86 VA、BA 1 10 1 d 2 d 1 2
9 M/58 VA、BA 3 11 1 d 3 d 3 2
10 F/65 VA、BA、PCA 3 9 2 d 3 d 3 2
11 F/30 BA 6 15 3 d 3 d 0 0
12 F/57 VA、BA 1 18 3 d 3 d 2 1
13 M/51 VA、BA、PCA 0 11 3 d 3 d 死亡 6
14 M/45 VA、PCA 2 9 1 d 4 d 0 0
15 F/68 BA 2 8 7 d 7 d 0 1
16 M/68 VA、BA 2 6 1 d 7 d 1 1
17 M/64 BA、PCA 1 10 7 d 7 d 2 1
18 M/32 VA、BA 5 13 5 d 10 d 死亡 6
19 M/71 VA、PCA 2 6 7 d 15 d 0 0
20 F/53 BA 6 10 4 d 16 d 2 1
21 M/57 BA 0 4 5 d 16 d 0 0
图4 某62岁男性患者的影像学结果。患者既往高血压病史，因“头晕半天”入院，次日出现意识障碍行急诊介入治疗，术前NIHSS评分20分。图a为入院时DWI显示脑桥未见明显高信号显影，考虑DWI阴性脑梗死；图b为第2天复查DWI发现脑桥双侧梗死灶；图c为颅脑MRA后循环血管（椎-基底动脉及双侧PCA）均未显影；图d为术中脑血管造影正位片提示BA近端闭塞，置入SolitaireAB（4 mm×20 mm）取栓支架未见明显血栓，考虑BA慢性原位狭窄急性闭塞；图e为术中脑血管造影侧位片：微导管通过狭窄部位，远端显影；图f为术中脑血管造影侧位片：经微导管送入NEUROFORMEZ（4.0 mm×20 mm）支架至BA狭窄处，予GateWay球囊导管（2.25 mm×15 mm）至支架内扩张，BA狭窄得到改善，无回缩；图g为术后脑血管造影正位片：可见双侧PCA和小脑上动脉显影，椎-基底动脉前向血流良好（mTICI 3级）；图h为术后复查颅脑CT提示脑桥未见明显出血 注：NIHSS为美国国立卫生研究院卒中量表；DWI为弥散加权成像；MRA为磁共振血管造影；PCA为大脑后动脉；BA为基底动脉
1
Zhou M, Wang H, Zhu J, et al. Cause-specific mortality for 240 causes in China during 1990-2013: a systematic subnational analysis for the global burden of disease study 2013 [J]. Lancet, 2016, 387(10015): 251-272.
2
Seners P, Turc G, Oppenheim C, et al. Incidence, causes and predictors of neurological deterioration occurring within 24 h following acute ischaemic stroke: a systematic review with pathophysiological implications [J]. J Neurol Neurosurg Psychiatry, 2015, 86(1): 87-94.
3
Grotta JC, Welch KM, Fagan SC, et al. Clinical deterioration following improvement in the NINDS rt-PA stroke trial [J]. Stroke, 2001, 32(3): 661-668.
4
中国卒中学会, 中国卒中学会神经介入分会, 中华预防医学会卒中预防与控制专业委员会介入学组. 急性缺血性卒中血管内治疗中国指南2018 [J]. 中国卒中杂志, 2018, 13(7): 706-729.
5
Chen WH, Yi TY, Wu YM, et al. Safety of endovascular therapy in progressive ischemic stroke and anterior circulation large artery occlusion [J]. World Neurosurg, 2019, 122: e383- e389.
6
中华医学会神经病学分会. 中国急性缺血性脑卒中诊治指南2018 [J]. 中华神经科杂志, 2018, 51(9): 666-682.
7
Birschel P, Ellul J, Barer D. Progressing stroke: towards an internationally agreed definition [J]. Cerebrovasc Dis, 2004, 17(2-3): 242-252.
8
Seners P, Baron JC. Revisiting 'progressive stroke': incidence, predictors, pathophysiology, and management of unexplained early neurological deterioration following acute ischemic stroke [J]. J Neurol, 2018, 265(1): 216-225.
9
Thanvi B, Treadwell S, Robinson T. Early neurological delerioration in acute ischemic stroke: predictors, mechanisms and management [J]. Postgrad Med J, 2008, 84(944): 412-417.
10
Karameshev A, Arnold M, Schroth G, et al. Diffusion-weighted MRI helps predict outcome in basilar artery occlusion patients treated with intra-arterial thrombolysis [J]. Cerebrovasc Dis, 2011, 32(4): 393-400.
11
Zaidat OO, Yoo AJ, Khatri P, et al. Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement [J]. Stroke, 2013, 44(9): 2650-2663.
12
Lapergue B, Blanc R, Gory B, et al. Effect of endovascular contact aspiration vs stent retriever on revascularization in patients with acute ischemic stroke and large vessel occlusion: the ASTER randomized clinical trial [J]. JAMA, 2017, 318(5): 443-452.
13
Yoo AJ, Simonsen CZ, Prabhakaran S, et al. Refifining angiographic biomarkers of revascularization: improving outcome prediction after intra-arterial therapy [J]. Stroke, 2013, 44(9): 2509-2512.
14
Marks MP, Lansberg MG, Mlynash M, et al. Correlation of AOL recanalization, TIMI reperfusion and TICI reperfusion with infarct growth and clinical outcome [J]. J Neurointerv Surg, 2014, 6(10): 724-728.
15
Hacke W, Kaste M, Fieschi C, et a1. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS Ⅱ). Second European-Australasian Acute Stroke Study Investigators [J]. Lancet, 1998, 352 (9136): 1245-1251.
16
王拥军, 陈玉国, 吕传柱, 等. 卒中相关性肺炎诊治中国专家共识 (2019更新版) [J]. 中国卒中杂志, 2019, 14(12): 1251-1262.
17
Wang XL, Ma LJ, Hu XG, et a1. Application of the respiratory "critical care-sub-critical care-rehabilitation integrated management model" in severe stroke associated pneumonia [J]. BMC Pulm Med, 2020, 20(1): 61.
18
Emsley HC, Hopkins SJ. Acute isehaemie stroke and infection: recent and emerging concepts [J]. Lancet Neurol, 2008, 7(4): 341-353.
19
Colomina-Climent F, Giménez-Esparza C, Portillo-Requena C, et al. Mortality reduction in septic shock by plasma adsorption (ROMPA): a protocol for a randomised clinical trial [J]. BMJ Open, 2016, 6(7): e011856.
20
Yu Z, Zeng Z, Zhang J, et al. Fatal community-acquired pneumonia in children caused by re-emergent human adenovirus 7d associated with higher severity of illness and fatality rate [J]. Sci Rep, 2016, 6: 37216.
21
Nagle RT, Leiby BE, Lavu H, et al. Pneumonia is associated with a high risk of mortality after pancreaticoduodenectomy [J]. Surgery, 2017, 161(4): 959-967.
22
Phua J, Dean NC, Guo Q, et al. Severe community-acquired pneumonia: timely management measures in the first 24 hours [J]. Crit Care, 2016, 20(1): 237.
23
McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure [J]. Eur Heart J, 2021, 42(36): 3599-3726.
24
马冬璞, 肖茜茜, 李菲菲, 等. 替罗非班治疗进展性脑梗死临床观察 [J]. 中国实用神经疾病杂志, 2020, 23(7): 576-580.
25
景黎君, 杨静尘, 杨伟民. 进展性缺血性脑卒中研究现状 [J]. 华西医学, 2020, 35(6): 646-651.
26
李讷, 郑龙. 卒中后进展的临床诊治综述 [J]. 世界最新医学信息文摘, 2019, 19(52): 37-39.
27
Koh SH, Park CY, Kim MK, et al. Microbleeds and free active MMP-9 are independent risk factors for neurological deterioration in acute lacunar stroke [J]. Eur J Neurol, 2011, 18(1): 158-164.
28
Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between defificit and infarct [J]. N Engl J Med, 2018, 378(1): 11-21.
29
Albers GW, Marks MP, Kemp S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging [J]. N Engl J Med, 2018, 378(8): 708-718.
30
Yang P, Zhang Y, Zhang L, et al. Endovascular thrombectomy with or without intravenous Alteplase in acute stroke [J]. N Engl J Med, 2020, 382(21): 1981-1993.
31
Jauch EC, Saver JL, Adams HP, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association [J]. Stroke, 2013, 44(3): 870-947.
32
Sugiyama T, Kazumata K, Asaoka K, et al. Reappraisal of microsurgical revascularization for anterior circulation ischemia in patients with progressive stroke [J]. World Neurosurg, 2015, 84(6): 1579-1588.
33
Wyszomirski A, Szczyrba S, Tomaka D, et al. Treatment of acute basilar artery occlusion: systematic review and meta-analysis [J]. Neurol Neurochir Pol, 2017, 51(6): 486-496.
34
Liu X, Dai Q, Ye R, et al. Endovascular treatment versus standard medical treatment for vertebrobasilar artery occlusion (BEST): an open-label, randomised controlled trial [J]. Lancet Neurol, 2020, 19(2): 115-122.
35
Wang Y, Ke Y, Wang L, et al. Safety and efficacy of endovascular treatment for progressive stroke in patients with acute basilar artery occlusion [J]. Front Neurol, 2021, 12: 774443.
36
Chimowitz MI, Lynn MJ, Derdeyn CP, et al. Stenting versus aggressive medical therapy for intracranial arterial stenosis [J]. N Engl J Med, 2011, 365(11): 993-1003.
37
SSYLVIA Study Investigators. Stenting of symptomatic atherosclerotic lesions in the vertebral or intracranial arteries (SSYLVIA): study results [J]. Stroke, 2004, 35(6): 1388-1392.
38
Foley LM, Hitchens TK, Barbe B, et al. Quantitative temporal profiles of penumbra and infarction during permanent middle cerebral artery occlusion in rats [J]. Transl Stroke Res, 2010, 1(3): 220-229.
39
Touzani O, Young AR, Derlon JM, et al. Progressive impairment of brain oxidative metabolism reversed by reperfusion following middle cerebral artery occlusion in anaesthetized baboons [J]. Brain Res, 1997, 767(1): 17-25.
40
Kang R, Gamdzyk M, Tang H, et al. Delayed recanalization-how late is not too late? [J]. Transl Stroke Res, 2021, 12(3): 382-393.
41
Rahman AA, Amruta N, Pinteaux E, et al. Neurogenesis after stroke: a therapeutic perspective [J]. Transl Stroke Res, 2021, 12(1): 1-14.
42
Tang H, Gamdzyk M, Huang L, et al. Delayed recanalization after MCAO ameliorates ischemic stroke by inhibiting apoptosis via HGF/c-Met/STAT3/Bcl-2 pathway in rats [J]. Exp Neurol, 2020, 330: 113359.
43
Zheng W, Matei N, Pang J, et al. Delayed recanalization at 3 days after permanent MCAO attenuates neuronal apoptosis through FGF21/FGFR1/PI3K/Caspase-3 pathway in rats [J]. Exp Neurol, 2019, 320: 113007.
44
Vora NA, Shook SJ, Schumacher HC, et al. A 5-item scale to predict stroke outcome after cortical middle cerebral artery territory infarction: validation from results of the diffusion and perfusion imaging evaluation for understanding stroke evolution (DEFUSE) Study [J]. Stroke, 2011, 42(3): 645-649.
45
Fanou EM, Knight J, Aviv RI, et al. Effect of collaterals on clinical presentation, baseline imaging, complications, and outcome in acute stroke [J]. AJNR Am J Neuroradiol, 2015, 36(12): 2285-2291.
46
Lansberg MG, Cereda CW, Mlynash M, et al. Response to endovascular reperfusion is not time-dependent in patients with salvageable tissue [J]. Neurology, 2015, 85(8): 708-714.
47
Hao Y, Yang D, Wang H, et al. Predictors for symptomatic intracranial hemorrhage after endovascular treatment of acute ischemic stroke [J]. Stroke, 2017, 48(5): 1203-1209.
48
Legrand L, Tisserand M, Turc G, et al. Fluid-attenuated inversion recovery vascular hyperintensities-diffusion-weighted imaging mismatch identifies acute stroke patients most likely to benefit from recanalization [J]. Stroke, 2016, 47(2): 424-427.
49
Verclytte S, Fisch O, Colas L, et al. ASL and susceptibility-weighted imaging contribution to the management of acute ischaemic stroke [J]. Insights Imaging, 2017, 8(1): 91-100.
[1] 凌海平, 那世杰, 刘涛, 庄宗, 张玉华, 张庆荣, 杭春华. 支架辅助弹簧圈栓塞治疗血泡样动脉瘤的临床疗效分析[J]. 中华脑科疾病与康复杂志(电子版), 2021, 11(05): 263-267.
[2] 徐志嘉, 贾振宇, 赵林波, 刘圣, 施海彬, 曹月洲. 高敏肌钙蛋白T动态变化在晚时间窗内进行血管内治疗的急性缺血性脑卒中患者中的预测价值[J]. 中华介入放射学电子杂志, 2023, 11(01): 42-47.
[3] 赖和泰, 刘羽, 程光森, 刘永康, 李忠亮, 陆骊工. 39例Surpass Streamline治疗未破裂动脉瘤患者诊疗分析：单中心临床经验[J]. 中华介入放射学电子杂志, 2023, 11(01): 19-24.
[4] 陈正文, 李沛城, 陈珑, 刘一之, 李波, 袁晨, 侯凯文. 后循环急性缺血性脑卒中患者经机械取栓完全复流后不良预后的影响因素分析[J]. 中华介入放射学电子杂志, 2022, 10(01): 22-26.
[5] 孙世蒙, 李天晓, 李立, 邵秋季, 常凯涛, 吴桥伟. 国产Tubridge血流导向装置治疗椎动脉夹层动脉瘤的初步应用[J]. 中华介入放射学电子杂志, 2021, 09(02): 160-164.
[6] 杭宇, 贾振宇, 曹月洲, 赵林波, 黄璜, 栾丽芹, 施海彬, 刘圣. 分级转运与会诊治疗模式对急性大血管闭塞性脑卒中血管内治疗效率与疗效的影响[J]. 中华介入放射学电子杂志, 2021, 09(02): 155-159.
[7] 王俊杰, 尹晓亮, 刘二腾, 陆军, 祁鹏, 胡深, 杨希孟, 陈鲲鹏, 张东, 王大明. 机器学习对预测颈内动脉非急性闭塞患者血管内再通术成功的潜在价值[J]. 中华脑血管病杂志(电子版), 2023, 17(05): 464-470.
[8] 孙洪扬, 刘基, 龚字翔, 王广英, 宁召腾, 赵璇, 朱其义, 王贤军. 急性前循环大血管闭塞性轻型卒中血管内治疗的临床预后及手术时机选择[J]. 中华脑血管病杂志(电子版), 2023, 17(05): 445-451.
[9] 袁兴运, 陈万红, 鱼丽萍, 姚力. 以Wallenberg综合征起病的椎动脉颅外段闭塞介入治疗探讨[J]. 中华脑血管病杂志(电子版), 2023, 17(04): 394-399.
[10] 杜小林, 陈鄂, 康俊龙, 肖庆, 丰伟, 田新华. 椎-基底动脉夹层动脉瘤介入治疗的疗效分析[J]. 中华脑血管病杂志(电子版), 2023, 17(04): 350-358.
[11] 张文胜, 幸伟芳, 谢颖, 何锦照. 急性前循环大血管闭塞血管内治疗头颅CT高密度影的研究进展[J]. 中华脑血管病杂志(电子版), 2023, 17(02): 159-162.
[12] 钱锦宏, 吴建东, 丁志良, 董晓峰, 唐晓宇, 马冕, 邓朋. 慢性症状性颈内动脉闭塞开通的初步探索[J]. 中华脑血管病杂志(电子版), 2022, 16(06): 416-421.
[13] 李伟, 乜全民, 王增武, 郭晖, 秦时强. 后循环血管形态改变对急性椎基底动脉闭塞患者机械取栓临床预后的影响[J]. 中华脑血管病杂志(电子版), 2022, 16(05): 320-325.
[14] 陈东升, 张萌, 张彩兰, 孙支唐. 急性基底动脉闭塞血管内治疗的研究进展[J]. 中华脑血管病杂志(电子版), 2022, 16(05): 360-365.
[15] 彭涛, 张紫霓, 朱碧峰, 但毕堂. 前循环串联病变血管内治疗预后的影响因素分析[J]. 中华脑血管病杂志(电子版), 2021, 15(05): 319-322.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号