| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 682.09 KB | Adobe PDF |
Advisor(s)
Abstract(s)
Introdução – De acordo com o Programa Nacional para as doenças cardio-cerebrovasculares de 2017, a OCDE refere que as doenças cardiovasculares são a principal causa de morte nos Estados-membros da União Europeia, representando cerca de 36% das mortes na região em 2010. Neste valor incluem-se as doenças cerebrovasculares. Pretendeu-se, com este estudo, avaliar o valor de fluxo sanguíneo cerebral (CBF) que melhor prevê o outcome resultante do procedimento da Via Verde no acidente vascular cerebral (AVC) em doentes submetidos a trombectomia. Também foi propósito deste estudo aumentar a fiabilidade do prognóstico, otimizando os procedimentos técnicos radiológicos na determinação dos volumes de core e penumbra. Método – Tratou-se de um estudo retrospetivo cujos casos clínicos foram recolhidos da base de dados do Hospital de Beatriz Ângelo (Loures, PT), com fundamento em critérios de inclusão pré-definidos. Após a aquisição da tomografia computorizada de perfusão (PCT) a uma amostra de 17 doentes, admitidos através do programa Via Verde AVC, foi realizado o pós-processamento com recurso ao software syngo.via (aplicação Neuro Perfusion). Os dados resultantes dos mapas de perfusão foram analisados estatisticamente através da aplicação SPSS® [IBM v. 23.0], permitindo uma análise que considerou os valores de CBF e respetivos volumes de core e penumbra. Resultados – Verificou-se que não existe correlação estatisticamente significativa entre a idade, tempo de evolução do AVC e ASPECTS pré-terapêutica com as restantes variáveis em estudo. Relacionando o ASPECTS pós-terapêutica com os níveis de core 10, 20 e 30 de CBF verificou-se que quanto maior o valor de ASPECTS menor o volume de core. Detetou-se uma redução estatisticamente significativa (p=0,003) dos valores de ASPECTS do pré para o pós-terapêutica. O valor core 10CBF apresenta
menor volume de tecido cerebral envolvido em relação ao core 30CBF, notando-se uma tendência inversa com o volume de penumbra. Conclusão – Este estudo demonstra que é possível, com um CBF de 10mL / 100g / min, restabelecer o fluxo necessário para restaurar a função neurológica do tecido afetado, sendo que com este CBF se obtém o maior volume de tecido cerebral para a penumbra e um menor volume de core. O processamento e interpretação dos mapas de perfusão influencia a variação dos valores finais do volume de core e penumbra.
ABSTRACT - Introduction – According to the 2017 Portuguese Program for Cardio-Cerebrovascular Diseases, the OECD reports that cardiovascular diseases are the leading cause of death in member states of the European Union, representing about 36% of deaths in the region in 2010. This figure includes brain vascular diseases. It was intended to evaluate the value of cerebral blood flow (CBF) that best predicts the outcomes from the Via Verde procedure in stroke, with patients undergoing thrombectomy. It was also the purpose of this study to increase the reliability of prognosis, optimizing the technique and radiological procedures for determining volumes of ‘core’ and ‘penumbra’. Methods – This was a retrospective study whose clinical cases were collected from the database of Hospital de Beatriz Ângelo (Loures, PT) based on predefined inclusion criteria. After the acquisition of perfusion computed tomography (PCT), a sample of 17 patients, admitted through the Via Verde stroke program, was post-processed using the syngo.via software (NEURO Perfusion application). The data resulting from the perfusion maps were analyzed statistically using the SPSS® [IBM v. 23.0], allowing an analysis that reflected the CBF values related to the volumes of ‘core’ and ‘penumbra’. Results – It was found that there is no statistically significant correlation between age, stroke time extends, and pre-therapeutic ASPECTS with the other variables under study. Relating the post-therapeutic ASPECTS to the core levels 10, 20, and 30 of CBF, it was found that the higher value of ASPECTS corresponds lower volume of the core. A statistically significant reduction (p=0.003) of the ASPECTS values was detected from pre- to post-therapy. The ‘core’ 10CBF value presents a lower volume of brain tissue infarcted in relation to the ‘core’ 30CBF, pointing to an inverse trend with the value of ‘penumbra’ volume. Conclusion – This study proves that it is possible, with a CBF of 10mL / 100g / min, to restore the flow needed to repair the neurological function of affected tissue, and with this CBF the largest volume of brain tissue is obtained for the ‘penumbra’ and a lower volume of ‘core’. The processing and interpretation of the perfusion maps induce variation in the volume of the score of ‘core’ and ‘penumbra’.
ABSTRACT - Introduction – According to the 2017 Portuguese Program for Cardio-Cerebrovascular Diseases, the OECD reports that cardiovascular diseases are the leading cause of death in member states of the European Union, representing about 36% of deaths in the region in 2010. This figure includes brain vascular diseases. It was intended to evaluate the value of cerebral blood flow (CBF) that best predicts the outcomes from the Via Verde procedure in stroke, with patients undergoing thrombectomy. It was also the purpose of this study to increase the reliability of prognosis, optimizing the technique and radiological procedures for determining volumes of ‘core’ and ‘penumbra’. Methods – This was a retrospective study whose clinical cases were collected from the database of Hospital de Beatriz Ângelo (Loures, PT) based on predefined inclusion criteria. After the acquisition of perfusion computed tomography (PCT), a sample of 17 patients, admitted through the Via Verde stroke program, was post-processed using the syngo.via software (NEURO Perfusion application). The data resulting from the perfusion maps were analyzed statistically using the SPSS® [IBM v. 23.0], allowing an analysis that reflected the CBF values related to the volumes of ‘core’ and ‘penumbra’. Results – It was found that there is no statistically significant correlation between age, stroke time extends, and pre-therapeutic ASPECTS with the other variables under study. Relating the post-therapeutic ASPECTS to the core levels 10, 20, and 30 of CBF, it was found that the higher value of ASPECTS corresponds lower volume of the core. A statistically significant reduction (p=0.003) of the ASPECTS values was detected from pre- to post-therapy. The ‘core’ 10CBF value presents a lower volume of brain tissue infarcted in relation to the ‘core’ 30CBF, pointing to an inverse trend with the value of ‘penumbra’ volume. Conclusion – This study proves that it is possible, with a CBF of 10mL / 100g / min, to restore the flow needed to repair the neurological function of affected tissue, and with this CBF the largest volume of brain tissue is obtained for the ‘penumbra’ and a lower volume of ‘core’. The processing and interpretation of the perfusion maps induce variation in the volume of the score of ‘core’ and ‘penumbra’.
Description
Keywords
Tomografia computorizada de perfusão ASPECTS Acidente vascular cerebral AVC Fluxo sanguíneo cerebral Penumbra Core Trombectomia Computed tomography perfusion Stroke Cerebral blood volume Thrombectomy
Citation
Monteiro AC, Striyenku K, Ferreira NP, Cacito AS, Carolino E, Ribeiro M, et al. Tomografia computorizada de perfusão cerebral no AVC isquémico: previsão do ASPECTS final através dos valores de core e penumbra. Saúde & Tecnologia. 2021;(25):25-37.
Publisher
Instituto Politécnico de Lisboa, Escola Superior de Tecnologia da Saúde de Lisboa