Application Of CTP In Interventional Treatment Of Middle Cerebral Artery

Objective:(1)Observe the change of CTP before and after intravascular treatment of symptomatic middle cerebral artery stenosis and the outcome of treatment,and evaluate the effectiveness of middle cerebral artery interventional surgery.(2)Through the brain CTP examination to select patients for interventional treatment,and assess the effect after treatment.To evaluate the value of craniocerebral CTP in the selection of indications and prognostic evaluation of symptomatic middle cerebral artery stenosis.Method:Analysis of cases of acute ischemic cerebrovascular disease hospitalized during the interventional period of ischemic cerebrovascular disease from December 2015 to October 2017 in our department of neurology was carried out.All patients were in line with the diagnostic criteria for acute ischemic stroke in the 2014 guidelines for acute ischemic stroke in China.70 of them were selected as research subjects,all patients were examined by Computed tomography(CT),CT angiography(Computedtomography angiography,CTA)and CT perfusion imaging(Computed tomography perfusion,CTP).No large area cerebral infarction was found in all patients through MRI examination.Understanding of the large vessels of the head and neck of the arch(innominate artery,subclavian artery,carotid artery,and extracranial segment of vertebral artery)and the location and degree of intracranial vascular stenosis.A total of 70 patients were enrolled in the study for symptomatic middle cerebral artery stenosis.The conditions were consistent with CTA and CTP examinations in all patients.All patients were confirmed to have unilateral middle cerebral artery stenosis(stenosis ranged from 70% to 99%)and poor collateral circulation.The degree of stenosis or stenosis was less than 25% in bilateral common carotid artery,internal carotid artery and middle cerebral artery.Magnetic resonance DWI sequence examination confirmed that infarct size > 1/3 hemisphere was out of the scope of this study.Both groups received aspirin 100 mg plus clopidogrel 75 mg atorvastatin tablets 10 mg daily on the day of regular admission.3 months of continuous oral administration,.Acute phase intravenous administration of drugs for 2 weeks to improve circulation and improve metabolic drugs in the brain.Of the 70 patients,35 underwent middle cerebral artery stenting,and 35 were not treated with interventional therapy.Patients with TIA infarction by the early CTP stage: all the patients were in stage II,including 15 cases of II1 patients,27 cases of patients with II stage 2;interventional treatment of patients with a total of 20 cases,including 7 cases of stage II1,13 stage II2 cases,drug treatment group of 22 cases,including 8 cases of stage II1,stage II2 in 14 cases.In the intervention group of 20 patients with TIA and 15 patients with cerebral infarction,including 21 cases of male,female 14 cases,age 78-35 years,mean age 56.30 + 6.52,the average rate of middle cerebral artery stenosis(80 + 2.35)%;the simple drug treatment group male 13 cases,female 22 cases,age 80-32 years old,mean age 58.20 + 4.32,the average rate of middle cerebral artery stenosis(82 + 3.40)%,two groups in gender,age,degree of stenosis,TIA staging before treatment,CTP parameters and NIHSS score before treatment compared with no significant difference.In the intervention group,35 cases of middle cerebral artery in 35 patients were treated by middle cerebral artery stenting.The average residual stenosis rate after interventional treatment was 20% + 2%.The blood flow was evaluated by immediate angiography,and all achieved the third grades of TICI classification.According to the indications and contraindications of interventional therapy for ischemic cerebrovascular disease,35 middle cerebral arteries of 35 patients in the trial group were treated with percutaneous intravascular stent implantation.All patients successfully completed the stent recanalization or thrombectomy.A total of 35 stents were placed.All 70 patients were followed for 3 months.In the experimental group,CTP examination and cerebral infarction patients NIHSS scores were performed 1 day before operation and 6 days after operation.Patients without interventional treatment were control group.On the first and seventh day of admission,CTP examination and cerebral infarction patients NIHSS score were performed.All patients received neurological recovery(mRS modified Rankin scale)at 3 months.Clinical analysis of the efficacy and complications of interventional therapy.Comparing two groups of different methods for the diagnosis and treatment of patients.Perfusion images of all patients were analyzed and measured at the blood supply area at the middle,middle,and posterior middle cerebral arteries.The cerebral blood flow(CBF),cerebral blood flow volume(CBV)contrast agent peak time(TTP)and mean transit time(MTT)were obtained.The rCBF,rCBV,rTTP,and rMTT were calculated by comparing the relative values of the affected side to the corresponding side of the contralateral side.The region of interest(ROI)avoids the large blood vessels and clear infarcts.Differences in bilateral preoperative blood perfusion and postoperative ischemic regional perfusion recovery were compared.Preoperative comparisons were made using a comparison of bilateral absolute values.Comparison of relative values before and after surgery.The non-surgical control group compared the difference of blood perfusion before and after treatment and the recovery of perfusion in the ischemic region after treatment,and the comparison of bilateral absolute values was used.Before and after treatment,relative values were compared.Result:(1)70 patients were 34 males and 36 females,aged 78-32 years,mean age 57.30±7.42.Brain CTA and CTP were performed on the first day of admission or within one day before intervention.The patients were all unilateral M1 segment Stenosis of middle cerebral arteries(degree of stenosis 70%-99%),bilateral common carotid artery,internal carotid artery,and brain.The arteries did not show significant stenosis or stenosis less than 25%.Compared with the healthy side,the index of CTP in the middle cerebral artery of the affected side showed that CBV and CBF were lower in the affected side than in the healthy side(P =0.005,0.001),and the TTP and MTT side were higher than the healthy side(P =0.003,0.005).(2)Among the 35 patients with middle cerebral artery stenosis or occlusion,21 were male and 14 were female.The age range was 78-35 years and the mean age was 56.30±6.52.Intracerebral CTA and CTP were performed within 1 day before admission and 6 days after intervention.Changes in CTP before and after treatment were compared with CBV,CBF,TTP,and MTT.CBV and CBF The relative ratio was higher than before treatment(P= 0.001,0.03),and the relative ratios of TTP and MTT were lower than before treatment(P =0.01,0.02).(3)35 cases of pure drug treatment were male 13 cases,female 22 cases,the age was 80-32 years old,the mean age was 58.20 + 4.32.Within first days after admission and seventh days after admission underwent brain CTA and CTP examination,the changes of CTP before and after treatment for CBV,CBF ratio and TTP ratio relative ratio,relative ratio of MTT were compared after the treatment,the CBV ratio is higher than that before treatment(P = 0.02),TTP,MTT,after treatment CBF treatment did not alter the relative ratio(P = 0.48,0.85,0.26).(4)In the 42 TIA patients,3 months after interventional therapy,17 cases of TIA stopped at follow-up,there were still 3 cases,and the effective rate was 85.00%.In the drug-treated group,13 cases of TIA stopped at 3 months and there were still 9 cases of seizures.The effective rate was 59.09%.The comparison between the two groups was P<0.05.(5)The NIHSS score was changed on the 6th day after interventional therapy and 1 day before interventional treatment,and compared with the NIHSS score on the 1st and 7th day of the simple drug treatment.At the same time,the mRS score was compared at 3 months.The NIHSS score of patients with interventional therapy was significantly different from that of patients treated with simple drugs(P = 0.02).MRS score at 3 months was lower than that of patients treated with simple drugs(P = 0.01).Conclusion:1.This study showed that CTP plays a very important role in the assessment of blood perfusion in patients with severe stenosis of the M1 segment of the middle cerebral artery.2.Middle cerebral artery stenting treatment can significantly improve the blood perfusion of the affected side,neurological function injury in patients with interventional therapy,and the degree of disability at 3 months after discharge is significantly reduced compared with those treated with drugs alone.3.The recurrent rate of TIA in patients with symptomatic middle cerebral artery M1 severe stenosis after middle cerebral artery stenting is low,and the treatment efficiency is higher than that of simple drug therapy.4.The parameters provided by the craniocerebral CTA and CTP can evaluate the cerebral collateral circulation and cerebral tissue perfusion,and provide support for the prognosis of the disease.It can guide the options of interventional therapy.The stent implantation in the middle cerebral artery can improve the blood flow of the middle cerebral artery.The quality of life of patients with ischemic cerebrovascular disease with interventional therapy is obviously improved,which is better than traditional medicine.