Yoo Albert J, Verduzco Luis A, Schaefer Pamela W, Hirsch Joshua A, Rabinov James D, González R Gilberto
Department of Neuroradiology and Interventional Neuroradiology, Massachusetts General Hospital, 55 Fruit Street, Gray 241, Boston, MA 02114, USA.
Stroke. 2009 Jun;40(6):2046-54. doi: 10.1161/STROKEAHA.108.541656. Epub 2009 Apr 9.
Recent studies demonstrate that an acute diffusion-weighted imaging lesion volume >70 cm(3) predicts poor outcome in patients with stroke. We sought to determine if this threshold could identify patients treated with intra-arterial therapy who would do poorly despite reperfusion. In patients with initial infarcts <70 cm(3), we sought to determine what effect recanalization and time to recanalization had on infarct growth and functional outcome.
We retrospectively studied 34 consecutive patients with anterior circulation stroke who underwent pretreatment diffusion-weighted imaging and perfusion-weighted imaging and subsequent intra-arterial therapy. Recanalization success and time to recanalization were recorded. Initial diffusion-weighted imaging and mean transit time lesion and final infarct volumes were determined. Patients were stratified based on initial infarct volume, recanalization status, and time to recanalization. Statistical tests were performed to assess differences in clinical and imaging outcomes. Good clinical outcome was defined as a 3-month modified Rankin Scale score <or=2.
Among patients with initial infarcts >70 cm(3), all had poor outcomes despite a 50% recanalization rate with mean infarct growth of 114 cm(3). These patients also had the largest mean transit time volumes (P<0.04). Patients with initial infarct volumes <70 cm(3) who recanalized early had the best clinical outcomes (P<0.008) with a 64% rate of modified Rankin Scale score <or=2 and the least infarct growth (P<0.03) with mean growth of 18 cm(3).
This study supports the use of an acute diffusion-weighted imaging lesion volume threshold as an imaging selection criterion for intra-arterial therapy. It also confirms the importance of early reperfusion in selected patients.
近期研究表明，急性弥散加权成像病变体积>70 cm³可预测卒中患者预后不良。我们试图确定该阈值能否识别接受动脉内治疗但即便再灌注仍预后不佳的患者。对于初始梗死体积<70 cm³的患者，我们试图确定再通及再通时间对梗死灶扩大和功能预后有何影响。
我们回顾性研究了34例连续的前循环卒中患者，这些患者在接受动脉内治疗前均进行了弥散加权成像和灌注加权成像。记录再通成功率及再通时间。确定初始弥散加权成像和平均通过时间病变以及最终梗死体积。根据初始梗死体积、再通状态及再通时间对患者进行分层。进行统计学检验以评估临床和影像学预后的差异。良好的临床预后定义为3个月改良Rankin量表评分≤2。
在初始梗死体积>70 cm³的患者中，尽管再通率为50%，平均梗死灶扩大114 cm³，但所有患者预后均不佳。这些患者的平均通过时间体积也最大（P<0.04）。初始梗死体积<70 cm³且早期再通的患者临床预后最佳（P<0.008），改良Rankin量表评分≤2的比例为64%，梗死灶扩大最少（P<0.03），平均扩大18 cm³。
本研究支持将急性弥散加权成像病变体积阈值用作动脉内治疗的影像学选择标准。它还证实了在特定患者中早期再灌注的重要性。
