Objective To investigate the significance of one-stop computed tomography perfusion(CTP) combined with computed tomography angiography(CTA)scan in guiding the treatment of internal carotid artery dissection(ICAD)-induced acute ischemic stroke(AIS). Method Thirty-nine cases of patients who were diagnosed of ICAD-induced with poor compensation by one-stop CTP combined with CTA scan from March 2014 to March 2017 were included into the study. There were seventeen cases of patients in the study group, all of whom underwent internal carotid artery dissection balloon dilation or stent angioplasty, and those who suffered from ICAD-induced AIS combined with distal vascular embolization were also treated with Solitaire stent arterial embolectomy. The control group was composed of twenty-two cases of patients who did not agree to accept interventional surgery or had surgical contraindications, and they were treated with intravenous thrombolysis and/or anticoagulation therapy. Results There were no significant differences between the two groups in general information, the NIHSS score upon admission and the duration from onset to admission(P>0.05). The study group was significantly higher than the control group in the change of NIHSS scores after treatment(P<0.05). The control group was significantly higher than the control group in the clinical prognosis after three months(P<0.05). The recanalization rate of the study group was significantly higher than that of the control group(P<0.05). There were no significant differences between the two groups in incidence rates of symptomatic intracranial hemorrhage, high perfusion encephalopathy and other complications(P>0.05). The mortality rates of patients in the study group were significantly lower than those in the control group(P<0.05). The patients in the study group did not present complications induced by interventional surgery such as hematoma in puncture sites, contrast agent allergy and contrast induced nephropathy. Conclusion Screening patients with ICAD-induced AIS, poor collateral circulation and insufficient compensation from those with super early stage of AIS through the one-stop CTP combined with CTA scan, and adopting effective interventional treatment can effectively improve the recanalization rate of vascular occlusion, short-term clinical curative effect and long-term prognosis, so as to reduce mortality and disability rates.%目的 探讨一站式CT灌注(CTP)联合CT血管造影(CTA)扫描对颈内动脉夹层(ICAD)致急性缺血性卒中(AIS)治疗的指导意义.方法 本研究2014年3月至2017年3月采用一站式CTP联合CTA扫描筛查出的ICAD致AIS且代偿差患者共39例,其中观察组17例,均急诊行ICAD闭塞处球囊扩张或支架成形术,若合并远端大血管栓塞者予行Solitaire支架动脉取栓术治疗.对照组为不同意介入手术或存在手术禁忌证的患者22例,选择静脉溶栓或/和抗凝治疗.结果 2组患者一般情况及入院时NIHSS评分、发病至入院时间对比,(P>0.05).治疗后2组美国国立卫生研究院卒中量表(NIHSS)评分变化,观察组明显优于对照组(P<0.05).3月后临床预后对比,观察组明显优于对照组(P<0.05).观察组血管再通率明显高于对照组(P<0.05).2组患者症状性颅内出血、高灌注脑病等并发症的发生率对比,(P>0.05).观察组患者及死亡率明显低于对照组(P<0.05).观察组患者均未出现穿刺部位血肿、对比剂过敏、造影剂肾病等介入操作相关性并发症.结论 通过一站式CTP联合CTA扫描从超早期AIS患者中筛查出ICAD致AIS且侧支循环差、代偿不足的患者,采用积极有效的干预治疗,既能有效地提高闭塞血管的再通率,且明显改善患者近期临床疗效及远期临床预后,降低死亡率及致残率.
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