| BackgroundWith the significant improvement of people’s living standard,the incidence of cardiovascular and cerebrovascular diseases is increasing.Acute cerebral infarction,with its high incidence,disability rate and fatality rate,has brought a very significant threat to people’s life and health.In clinical practice,some advanced diagnostic and therapeutic techniques have been widely used.Selective intravenous thrombolysis has achieved significant curative effect on patients with cerebral infarction.Acute cerebral infarction has a strict time window,that is,within 4.5 hours of onset,most of the thrombolytic treatment is effective.The treatment sooner or later determines the key to prognosis.Therefore,it is very imperative to adopt a positive and effective early diagnosis method for patients with acute cerebral infarction.It is very crucial to select the appropriate treatment method and predict the therapeutic effect of patients according to the individual differences.ObjectiveThe collateral circulation of patients with acute cerebral infarction was evaluated by CT Angiography(CTA).By comparing the changes of parameters in ischemic penumbra before and after intravenous thrombolysis and the recovery of nerve function,the effects of collateral circulation on thrombolysis and nerve function in ischemic penumbra were analyzed.Methods50 patients with acute cerebral infarction treated in neurology department of our hospital from January 1,2017 to June 1,2019 were selected as research objects.Head CTplain scan,CT angiography and CT cerebral perfusion(CTP)examination were completed within 4.5 hours of onset.All patients were scanned by 256-slice spiral CT.Cerebral hemorrhage was excluded by CT plain scan.CTA proved to be cerebral infarction patients with unilateral middle cerebral artery occlusion.All patients were treated with recombinant tissue plasminogen activator(rt-PA)for intravenous thrombolysis.36 patients with Ischemic Penumbra(IP)were screened by CTP.The patients with IP were divided into the good collateral circulation group and the bad collateral circulation group by Maximum intensity projection(MIP)of CT angiography.Among them,20 patients in the good collateral circulation group and 16 patients in the bad collateral circulation group.The general clinical data of the two groups of patients were recorded respectively,and whether there were significant differences in age,smoking,obesity,chronic diseases(diabetes,hypertension,hyperlipidemia,etc.)and other risk factors between the two groups were compared.The importance of collateral circulation in venous thrombolysis therapy and prognosis evaluation was analyzed.CTP was performed on the 7th day of intravenous thrombolysis using the same machine and scanning conditions The values of various parameters of ischemic brain tissue were recorded after thrombolysis to analyze and discuss the importance of the opening of collateral circulation in the evaluation of thrombolysis and prognosis.The national institutes of health stroke scale(NIHSS)score before admission,7d and 14 d NIHSS score after thrombolysis,and 90 d mRS score after thrombolysis in the two groups were recorded.ResultsIn routine scan CT,only 21 cases of the onset of symptoms and signs except for the scan area,the positive rate is 42.0%,42 patients of CTP according to abnormal,positive rate was 84.0%,all the CTP parameters in patients with abnormal for first routine CT or confirmed by review of the new area of infarction lesions,and the patient’s clinical symptoms and physical signs.CTA results showed that all patients had unilateral middle cerebral artery occlusion,and the contralateral middle cerebral artery was normal orslightly narrowed.According to the CTA-MIP image,it was divided into good circulation group and bad collateral circulation group.There was no significant difference between the two groups in age,blood glucose,total cholesterol(TC),low densith lipoprotein(LDL),hypertension,smoking and other factors,respectively(P>0.05).However,the cerebral blood volume(CBV)and cerebral blood flow(CBF)of the good collateral circulation group before and after treatment were all higher than those of the bad collateral circulation group(P<0.05).The time to peak(TTP)and Mean transit time(MTT)of the bad collateral circulation group before and after treatment were significantly extended(P<0.05).After thrombolytic therapy,CBV and CBF increased in both groups.The values of CBV and CBF were higher in the good group,and the values of MTT and TTP were significantly decreased in the good group.The values of the good collateral circulation group were closer to those of the healthy group.When comparing the national institutes of health stroke scale(NIHSS)score on admission and thrombolytic treatment for 7 and 14 days and the Modified Rank scale(MRS)score for discharge for 90 days,the good group was significantly lower than the bad group(P<0.05).ConclusionCTA combined with CTP can be used for early diagnosis of acute cerebral infarction and IP detection.Post-processing images and parameter values can effectively assess the collateral circulation and cerebral blood perfusion of patients with acute cerebral infarction.Moreover it can also predict the effect of thrombolytic atherapy.The opening of collateral circulation was positively correlated with the efficacy of thrombolysis. |
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