Olindo Stephane, Chausson Nicolas, Joux Julien, Saint - Vil Martine, Signate Aissatou, Edimonana-Kapute Mireille, Jeannine Severine, Mejdoubi Mehdi, Aveillan Mathieu, Cabre Philippe, Smadja Didier
Department of Neurology, University Hospital of Fort-de-France, Martinique, French West Indies.
Arch Neurol. 2012 Nov;69(11):1462-8. doi: 10.1001/archneurol.2012.1310.
Few data are available on the relationship between fluid-attenuated inversion recovery vascular hyperintensities and proximal middle cerebral artery occlusion prognosis.
To assess a fluid-attenuated inversion recovery vascular hyperintensities score (FVHS) and explore its relationship with recanalization status and clinical outcomes after intravenous thrombolysis.
Retrospective study.
Stroke unit in a university hospital.
Consecutive patients with proximal middle cerebral artery occlusion, thrombolysed within 6 hours, were selected from our prospective database. The FVHS (range,0-10; divided into low, medium, and high thirds) was quantified on the magnetic resonance image obtained at admission. Recanalization rates, infarction size (Alberta Stroke Program Early CT Score applied to diffusion weighted imaging [ASPECTS-DWI]), and 3-month functional outcomes (modified Rankin Scale score) were determined. Poor outcomes and large infarctions were defined as a modified Rankin Scale score higher than 2and an ASPECTS-DWI score of 5 or lower, respectively.
Interaction among FVHS,recanalization status, and outcomes.
Thirty-four patients had a low FVHS (4), 32 had a medium FVHS (5 or 6), and 39 had a high FVHS (≥7). The rate of poor functional outcome (modified Rankin Scale score >2) was higher for the group with low FVHSs than those with medium FVHSs and high FVHSs(82.3% vs 43.7% and 43.5%, respectively; P.001). Therate of 24-hour large infarctions(ASPECTS-DWI score 5)was higher for those with low FVHSs than those with medium and high FVHSs (88.2% vs 56.2% and 51.3%, respectively;P=.002). The recanalization rate was not associated with FVHS. Multivariate analysis retained low FVHS as an independent early predictor of poor clinical outcome (odds ratio=9.91; 95% CI, 2.01-48.93; P=.004)and large infarction (odds ratio=6.99; 95% CI, 1.78-27.46; P=.005).Low FVHS remained associated with poor outcomes regardless of recanalization status. Early recanalization in patients with a low FVHS decreased the poor functional outcome rate from 100% to 64.7% (P=.02).
The FVHS is an early independent prognostic marker for patients with proximal middle cerebral artery occlusion. Synergy between FVHS and recanalization status appears to be a critical determinant of final outcomes, supporting intensive reperfusion treatment for patients with a low FVHS.
关于液体衰减反转恢复序列血管高信号与大脑中动脉近端闭塞预后之间关系的数据较少。
评估液体衰减反转恢复序列血管高信号评分（FVHS），并探讨其与静脉溶栓后再通状态及临床结局的关系。
回顾性研究。
大学医院的卒中单元。
从我们的前瞻性数据库中选取6小时内行溶栓治疗的大脑中动脉近端闭塞的连续患者。入院时获得的磁共振图像上对FVHS（范围0 - 10；分为低、中、高三等分）进行量化。确定再通率、梗死面积（应用于扩散加权成像的阿尔伯塔卒中项目早期CT评分[ASPECTS - DWI]）以及3个月时的功能结局（改良Rankin量表评分）。不良结局和大面积梗死分别定义为改良Rankin量表评分高于2分和ASPECTS - DWI评分5分及以下。
FVHS、再通状态和结局之间的相互作用。
34例患者FVHS低（4分），32例患者FVHS中等（5或6分），39例患者FVHS高（≥7分）。FVHS低的组功能不良结局（改良Rankin量表评分>2分）发生率高于FVHS中等和高的组（分别为82.3% vs 43.7%和43.5%；P<0.001）。FVHS低的患者24小时大面积梗死（ASPECTS - DWI评分5分）发生率高于FVHS中等和高的患者（分别为88.2% vs 56.2%和51.3%；P = 0.002）。再通率与FVHS无关。多因素分析显示FVHS低是临床结局不良（比值比 = 9.91；95%可信区间，2.01 - 48.93；P = 0.004）和大面积梗死（比值比 = 6.99；95%可信区间，1.78 - 27.46；P = 0.005）的独立早期预测指标。无论再通状态如何，FVHS低仍与不良结局相关。FVHS低的患者早期再通使功能不良结局发生率从100%降至64.7%（P = 0.02）。
FVHS是大脑中动脉近端闭塞患者的早期独立预后标志物。FVHS与再通状态之间的协同作用似乎是最终结局的关键决定因素，支持对FVHS低的患者进行强化再灌注治疗。
