出版简讯｜急性卒中伴灌注不足患者红细胞生成素预处理和多点钻孔后的血运重建模式及其特征
文摘
科学
2024-06-05 16:02
北京
Revascularisation patterns and characteristics after erythropoietin pretreatment and multiple burr holes in patients who had acute stroke with perfusion impairment
Seong-Joon Lee, So Young Park, Geun Hwa Park, Jin Soo Lee, Yong Cheol Lim, Ji Man Hongdoi: 10.1136/svn-2023-002831
Stroke & Vascular Neurology（SVN）新近上线文章“Revascularisation patterns and characteristics after erythropoietin pretreatment and multiple burr holes in patients who had acute stroke with perfusion impairment”，来自韩国亚洲大学医学院（Ajou University School of Medicine, AUSOM）Ji Man Hong等。血运重建术后可观察到经硬膜侧支，主要来自颅外颞浅动脉和颅内脑膜中动脉，通过颈外动脉（external carotid artery, ECA）形成。然而，在伴有灌注不足的卒中患者中，这些侧支的来源尚不清楚。鉴于此，作者团队根据这些侧支的来源探究了血运重建的模式和特征。作者团队采用促红细胞生成素预处理，并在局部麻醉下进行多点钻孔，以实现急性卒中伴灌注不足患者的硬膜外血运重建。6个月后，通过经股动脉脑血管造影评估血运重建模式。侧支循环分为颅内ECA主导（源自脑膜中动脉）、颅外ECA主导（源自颞浅动脉或枕动脉）和平衡组。比较这些组之间的各种成像参数。Figure 1. Flowchart of the procedure and subgrouping.
研究结果显示，共计87例患者，103个半球接受了治疗。其中，57.3%被归类为颅内ECA主导，20.4%被归类为颅外ECA主导，22.3%被归类为平衡。大多数具有颅内或颅外侧支（与平衡侧支相比）的半球均成功进行了血运重建（78/80 (97.5%) vs 12/23 (52.1%), p<0.001）。在随血运重建模式发生的超声血流动力学变化中，仅颅内ECA占主导地位的血运重建与ECA血流的特定变化显著相关，从而转换为低阻力ECA多普勒超声波形。Figure 2. Comparison of the revascularisation patterns of the intracalvarial external carotid artery dominancy and extracalvarial external carotid artery dominancy. *As compared with the extracalvarial ECA revascularisation pattern, there is no transcalvarial arteriogenesis in the intracalvarial ECA revascularisation pattern. †Revascularisation confirmed by transfemoral cerebral angiography after 6 months from multiburr hole operation.
Figure 3. Perfusion changes on the treated hemisphere before and after combined therapy. In comparison to the balanced revascularisation group, both the intracalvarial and extracalvarial revascularisation groups showed significant perfusion changes before and after the combined treatment.Figure 4. An illustrative case that highlights the haemodynamic changes in the external carotid artery (ECA) during the follow-up period. In this case, the ECA exhibited a transformation to a low-resistance ECA Doppler sonography waveform (indicated by the red box), which is referred to as ‘internalization of the ECA’. This change was observed in conjunction with the intracalvarial ECA revascularisation pattern in the 6-month transfemoral cerebral angiography follow-up. The figure illustrates how the ECA’s blood flow dynamics underwent a significant alteration as a result of the intracalvarial ECA revascularisation process.
研究结果表明，颅内ECA主导的血运重建在联合治疗后硬膜外侧支的形成中起着至关重要的作用。这些ECA血流动力学的明显变化可通过床边超声检查非侵入性地识别。更多内容详见文章原文：https://svn.bmj.com/content/early/2024/05/30/svn-2023-002831，或点击文末“阅读原文”。投稿 / 转载 / 商务合作：csa.svn@chinastroke.netEmail：csa.svn@chinastroke.net地址：北京市丰台区南四环西路119号B区1号楼508室本公众号对其刊载的所有内容，包括文字、图片、音视频资料以及版式设计等享有版权，未经本公众号授权同意，其他任何机构不得以任何形式侵犯本公众号作品著作权，包括但不限于：擅自复制、链接、非法使用或转载，或以任何方式建立作品镜像。转载请联系后台或邮箱。如获转载授权，发布请注明出处，不得擅自修改文章内容
