急性缺血性脑卒中血管内治疗中脑血容量值与预后的相关性
Correlation between cerebral blood volume values and outcomes in endovascular therapy for acute ischemic stroke.
作者信息
Mokin Maxim, Morr Simon, Fanous Andrew A, Shallwani Hussain, Natarajan Sabareesh K, Levy Elad I, Snyder Kenneth V, Siddiqui Adnan H
机构信息
Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA.
Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Toshiba Stroke Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA.
出版信息
J Neurointerv Surg. 2015 Oct;7(10):705-8. doi: 10.1136/neurintsurg-2014-011279. Epub 2014 Aug 21.
BACKGROUND
Neurointerventionalists do not agree about the optimal imaging protocol when evaluating patients with acute stroke for potential endovascular revascularization. Preintervention cerebrovascular blood volume (CBV) has been shown to predict outcomes in patients undergoing intra-arterial stroke therapies.
OBJECTIVE
To determine whether CBV can predict hemorrhagic transformation and clinical outcomes in patients selected for endovascular therapy for acute ischemic middle cerebral artery (MCA) stroke using a CT perfusion (CTP)-based imaging protocol.
METHODS
We retrospectively reviewed cases of acute ischemic stroke due to MCA M1 segment occlusion and correlated favorable clinical outcomes (modified Rankin scale (mRS) ≤2) and radiographic outcomes with preintervention CBV values. All patients underwent whole-brain (320-detector-row) CTP imaging, and absolute CBV values of the affected and contralateral MCA territories were obtained separately for the cortical and basal ganglia regions.
RESULTS
Relative CBV (rCBV) of the MCA cortical regions was significantly lower in patients with poor clinical outcomes than in those with favorable clinical outcomes (0.87±0.21 vs 1.02±0.09, p=0.0003), and a negative correlation was found between rCBV values and mRS score severity. rCBV of the basal ganglia region was significantly lower in patients with hemorrhagic infarction (p=0.004) and parenchymal hematoma (p=0.04) than in those without hemorrhagic transformation.
CONCLUSIONS
We found that cortical CBV loss is predictive of poor clinical outcomes, whereas basal ganglia CBV loss is predictive of hemorrhagic transformation but without translation into poor clinical outcomes. Our study findings support published results of baseline preintervention CBV as a predictor of outcomes in patients undergoing intra-arterial stroke therapies.
背景
在评估急性中风患者是否适合进行血管内血运重建时，神经介入医生对于最佳成像方案尚未达成共识。动脉内中风治疗患者的干预前脑血管血容量（CBV）已被证明可预测预后。
目的
使用基于CT灌注（CTP）的成像方案，确定CBV是否能预测急性缺血性大脑中动脉（MCA）中风接受血管内治疗患者的出血性转化和临床预后。
方法
我们回顾性分析了因MCA M1段闭塞导致的急性缺血性中风病例，并将良好的临床预后（改良Rankin量表（mRS）≤2）和影像学结果与干预前CBV值进行关联。所有患者均接受全脑（320排探测器）CTP成像，并分别获取患侧和对侧MCA区域皮质和基底节区的绝对CBV值。
结果
临床预后较差的患者MCA皮质区域的相对CBV（rCBV）显著低于临床预后良好的患者（0.87±0.21 vs 1.02±0.09，p = 0.0003），且rCBV值与mRS评分严重程度呈负相关。出血性梗死（p = 0.004）和脑实质血肿（p = 0.04）患者的基底节区rCBV显著低于无出血性转化的患者。
结论
我们发现皮质CBV降低可预测临床预后不良，而基底节CBV降低可预测出血性转化，但不会导致临床预后不良。我们的研究结果支持已发表的关于干预前基线CBV作为动脉内中风治疗患者预后预测指标的结果。
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