超越传统成像:评估计算机断层扫描灌注对缺血性脑卒中晚期预后影响的系统性综述和荟萃分析》(A Systematic Review and Meta-Analysis Assessing the Impact of Computed Tomography Perfusion on Ishemic Stroke Outcomes in the Late-Window.

IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY International Journal of Stroke Pub Date : 2024-11-10 DOI:10.1177/17474930241292915
Salah Elsherif, Brittney Legere, Ahmed Mohamed, Razan Saqqur, Nida Fatima, Maher Saqqur, Ashfaq Shuaib
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引用次数: 0

摘要

背景:非对比 CT(NCCT)和 CT 血管造影(CTA)已成为急性卒中血管内治疗(EVT)的必要手段。如果在选择患者时增加 CT 灌注成像(CTP),可能会改善患者选择。我们的目的是分析在急性缺血性卒中(AIS)患者治疗中实施 CTP 的效果,以评估在晚期窗口期卒中预后是否存在差异:我们在 PubMed、Embase 和 Web of Sciences 数据库中检索了与 EVT 中的 CTA 和 CTP 相关的文章。收集到的患者数据分为两组:CTP组和对照组(NCCT+CTA)。评估的主要结果是改良Rankin量表(mRS)评分、症状性颅内出血(sICH)、死亡率和成功再通:共有14项研究的5809名患者参与了最终分析:2602名患者接受了CTP治疗,3202名患者属于对照组。CTP/CTA患者的90天卒中相关死亡率明显降低(OR:0.72,95% CI 0.60-0.87,P 0.05):该研究强调了 CTP 引导治疗作为晚期窗口期 EVT 选择的辅助工具的实用性。虽然增加 CTP 可降低死亡率,但良好的预后并未改善。要更清楚地了解将 CTP 纳入卒中成像的潜在优势或局限性,还需要进一步的证据。
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Beyond conventional imaging: A systematic review and meta-analysis assessing the impact of computed tomography perfusion on ischemic stroke outcomes in the late window.

Background: Non-contrast cranial computed tomography (NCCT) and CT angiogram (CTA) have become essential for endovascular treatment (EVT) in acute stroke. Patient selection may improve when CT perfusion (CTP) imaging is also added for patient selection. We aimed to analyze the effects of implementing CTP in acute ischemic stroke (AIS) patients' treatment to assess whether stroke outcomes differ in the late window.

Methods: We searched the PubMed, Embase, and Web of Sciences databases to obtain articles related to CTA and CTP in EVT. Collected patient data were split into two groups: the CTP and control (NCCT + CTA) cohorts. Primary outcomes evaluated were modified Rankin Scale (mRS) scores, symptomatic intracranial hemorrhages (sICHs), mortality, and successful recanalization.

Results: There were 14 studies with 5809 total patients in the final analysis: 2602 received CTP and 3202 were in the control group. CTP/CTA patients showed significantly lower rates of 90-day stroke-related mortality (odds ratio (OR) = 0.72, 95% confidence interval (CI) = 0.60-0.87, p < 0.01) and significantly higher successful recanalization (OR = 1.42, 95% CI = 1.06-1.94, p < 0.01) compared with CTA-only patients. Analysis of other outcomes including functional independence (mRS = 0-2), critical times, and intracranial hemorrhages was non-significant (p > 0.05).

Conclusion: The study highlights the usefulness of CTP-guided therapy as a supplementary tool in EVT selection in the late window. Although the addition of CTP resulted in lower mortality, the favorable outcomes did not improve. Further evidence is required to establish a clearer understanding of the potential advantages or limitations of incorporating CTP in stroke imaging.

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来源期刊
International Journal of Stroke
International Journal of Stroke 医学-外周血管病
CiteScore
13.90
自引率
6.00%
发文量
132
审稿时长
6-12 weeks
期刊介绍: The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.
期刊最新文献
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