Bang O Y, Saver J L, Buck B H, Alger J R, Starkman S, Ovbiagele B, Kim D, Jahan R, Duckwiler G R, Yoon S R, Viñuela F, Liebeskind D S
Department of Neurology, Samsung Medical Centre, Sungkyunkwan University, Seoul, South Korea.
J Neurol Neurosurg Psychiatry. 2008 Jun;79(6):625-9. doi: 10.1136/jnnp.2007.132100. Epub 2007 Dec 12.
Collaterals may sustain penumbra prior to recanalisation yet the influence of baseline collateral flow on infarct growth following endovascular therapy remains unknown.
Consecutive patients underwent serial diffusion and perfusion MRI before and after endovascular therapy for acute cerebral ischaemia. We assessed the relationship between MRI diffusion and perfusion lesion indices, angiographic collateral grade and infarct growth. Tmax perfusion lesion maps were generated and diffusion-perfusion mismatch regions were divided into Tmax >or=4 s (severe delay) and Tmax >or=2 but <4 s (mild delay).
Among 44 patients, collateral grade was poor in 7 (15.9%), intermediate in 20 (45.5%) and good in 17 (38.6%) patients. Although diffusion-perfusion mismatch volume was not different depending on the collateral grade, patients with good collaterals had larger areas of milder perfusion delay than those with poor collaterals (p = 0.005). Among 32 patients who underwent day 3-5 post-treatment MRIs, the degree of pretreatment collateral circulation (r = -0.476, p = 0.006) and volume of diffusion-perfusion mismatch (r = 0.371, p = 0.037) were correlated with infarct growth. Greatest infarct growth occurred in patients with both non-recanalisation and poor collaterals. Multiple regression analysis revealed that pretreatment collateral grade was independently associated with infarct growth.
Our data suggest that angiographic collateral grade and penumbral volume interactively shape tissue fate in patients undergoing endovascular recanalisation therapy. These angiographic and MRI parameters provide complementary information about residual blood flow that may help guide treatment decision making in acute cerebral ischaemia.
在再通之前侧支循环可能维持半暗带，但血管内治疗后基线侧支血流对梗死灶生长的影响尚不清楚。
连续纳入急性脑缺血患者，在血管内治疗前后进行系列扩散加权成像和灌注加权成像。我们评估了MRI扩散和灌注病变指数、血管造影侧支分级与梗死灶生长之间的关系。生成Tmax灌注病变图，并将扩散-灌注不匹配区域分为Tmax≥4秒（严重延迟）和Tmax≥2但<4秒（轻度延迟）。
44例患者中，侧支分级差的有7例（15.9%），中等的有20例（45.5%），好的有17例（38.6%）。尽管扩散-灌注不匹配体积不因侧支分级而异，但侧支良好的患者较侧支差的患者有更大面积的轻度灌注延迟（p = 0.005）。在32例治疗后第3 - 5天接受MRI检查的患者中，治疗前侧支循环程度（r = -0.476，p = 0.006）和扩散-灌注不匹配体积（r = 0.371，p = 0.037）与梗死灶生长相关。梗死灶生长最大的发生在未再通且侧支差的患者中。多元回归分析显示，治疗前侧支分级与梗死灶生长独立相关。
我们的数据表明，血管造影侧支分级和半暗带体积在接受血管内再通治疗的患者中相互作用影响组织转归。这些血管造影和MRI参数提供了关于残余血流的补充信息，可能有助于指导急性脑缺血的治疗决策。
