磁共振血管成像的大脑后动脉偏侧优势对脑梗死预后研究

目的探讨磁共振血管成像(MRA)的大脑后动脉(PCA)偏侧优势对大脑中动脉闭塞患者使用重组组织型纤溶酶原激活剂(rt-PA)的预后价值。方法 53例大脑中动脉分布区梗死的急性缺血性脑卒中患者应用rt-PA静脉溶栓治疗、均在入院时常规进行初期(最初4.5h)MRI检查和定期头颅CT(脑卒中发病后14和21d)检查。将有PCA偏侧优势23例作为优势组,30例无偏侧优势作为无优势组。分析所有患者的临床和影像学数据。结果脑卒中发病后7d,与无优势组比较,优势组患者美国国立卫生研究院卒中量表评分较低[2.8分vs 13.5分,P=0.005],脑梗死面积较小[8.5分vs 6.0分,P=0.007],再灌注成功率高(82.6%vs 60.0%,P=0.001)。存在PCA偏侧优势的患者出现预后良好的校正风险比为8.11(95%CI:1.80⁵0.2,P=0.005)。结论可以将rt-PA静脉溶栓治疗前MRA中存在PCA偏侧优势用作预测大脑中动脉闭塞患者出现良好功能预后的指标。

Value of posterior cerebral artery laterality on MRA in predicting functional outcome in patients with acute ischemic stroke

Objective To study the value of posterior cerebral artery(PCA)laterality on MRA in predicting the functional outcome in patients with MCAO treated with intravenous recombinant tissue plasminogen activator.Methods Fifty-three acute ischemic stroke patients with MCAO treated with intravenous recombinant tissue plasminogen activator were included in this study.They underwent initial MRI in the first 4.5hafter admission and regular CT scanning on days14,21 after stroke onset.Twenty-three patients with PCA laterality served as a laterality group and 30 patients without PCA laterality served as a non-laterality group.Their clinical and radiologic data were analyzed.Results The NIHSS score was significantly lower,the cerebral infarction volume was significantly smaller,and the reperfusion rate was significantly higher in laterality group than in non-laterality group on day 7after stroke onset(2.8 vs 13.5,P=0.005;8.5 vs6.0,P=0.007;82.6%vs 60.0%,P=0.001).Multivariate logistic regression analysis showed an adjusted odds ratio of 8.11 for the favorable outcome in patients with PCA laterality(95%CI:1.80-50.2,P=0.005).Conclusion The presence of PCA laterality on MRA can predict the favorable functional outcome in MCAO patients before they are treated with intravenous recombinant tissue plasminogen activator probably by improving the recanalization rate.