Albers Gregory W, Goyal Mayank, Jahan Reza, Bonafe Alain, Diener Hans-Christoph, Levy Elad I, Pereira Vitor M, Cognard Christophe, Yavagal Dileep R, Saver Jeffrey L
From the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (G.W.A.); Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.G.); Division of Interventional Neuroradiology (R.J.) and Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine (J.L.S.), University of California Los Angeles; Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.); Department of Neurology, University Hospital of University Duisburg-Essen, Essen, Germany (H.-C.D.); Department of Neurosurgery, State University of New York at Buffalo, NY (E.I.L.); Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (V.M.P.); Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France (C.C.); and Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine, FL (D.R.Y.).
Stroke. 2015 Oct;46(10):2786-94. doi: 10.1161/STROKEAHA.115.010710. Epub 2015 Aug 27.
Imaging findings can predict outcomes in patients with acute stroke. Relationships between imaging findings and clinical and imaging outcomes in patients randomized to intravenous tissue-type plasminogen activator-alone versus tissue-type plasminogen activator plus endovascular therapy (Solitaire device) in the Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke (SWIFT PRIME) study were assessed.
We evaluated associations between imaging assessments (baseline mismatch profiles/ischemic core volumes and successful reperfusion) with imaging outcomes (27-hour infarct volume/growth) and clinical outcomes (modified Rankin Scale scores at 90 days). Imaging variables that predict favorable clinical outcomes were assessed in both univariate and multivariate models.
One hundred and ninety-five patients were included. Successful reperfusion and infarct volume (assessed at 27 hours) were powerful independent predictors of favorable clinical outcomes (modified Rankin Scale score of 0-2 at 90 days). Patients with the target mismatch profile at baseline had a higher rate of reperfusion, lesser infarct growth, smaller infarct volumes, and better clinical outcomes in the Solitaire plus tissue-type plasminogen activator (intervention) group than those in the tissue-type plasminogen activator-alone (control) group. Patients with larger mismatch volumes at baseline had a trend toward better treatment response in the intervention group than patients who had smaller (<50 mL) mismatch volumes.
Patients who achieved reperfusion had substantially more favorable clinical and imaging outcomes in both the intervention and the control groups. Infarct volume at 27 hours strongly correlated with clinical outcome at 90 days in both treatment groups. SWIFT PRIME patients with the target mismatch profile had a highly favorable response to endovascular therapy on both clinical and imaging outcomes. Both reperfusion and infarct volumes at 27 hours were powerful and independent predictors of 90-day clinical outcomes.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01657461.
影像学检查结果可预测急性卒中患者的预后。在“以血栓切除术为主要血管内治疗手段治疗急性缺血性卒中的Solitaire（SWIFT PRIME）研究”中，对随机接受单纯静脉注射组织型纤溶酶原激活剂与组织型纤溶酶原激活剂联合血管内治疗（Solitaire装置）的患者，评估其影像学检查结果与临床及影像学预后之间的关系。
我们评估了影像学评估（基线不匹配情况/缺血核心体积与成功再灌注）与影像学预后（27小时梗死体积/梗死灶增长）及临床预后（90天时改良Rankin量表评分）之间的关联。在单变量和多变量模型中评估预测良好临床预后的影像学变量。
共纳入195例患者。成功再灌注和梗死体积（27小时时评估）是良好临床预后（90天时改良Rankin量表评分为0 - 2）的有力独立预测因素。基线时具有目标不匹配情况的患者，与单纯组织型纤溶酶原激活剂治疗（对照组）相比，在Solitaire联合组织型纤溶酶原激活剂治疗（干预组）中再灌注率更高、梗死灶增长更小、梗死体积更小且临床预后更好。基线时不匹配体积较大的患者，与不匹配体积较小（<50 mL）的患者相比，干预组的治疗反应有更好的趋势。
在干预组和对照组中，实现再灌注的患者临床和影像学预后均明显更优。两个治疗组中，27小时时的梗死体积与90天时的临床预后密切相关。具有目标不匹配情况的SWIFT PRIME研究患者，血管内治疗在临床和影像学预后方面均有非常良好的反应。再灌注和27小时时的梗死体积均是90天临床预后的有力且独立的预测因素。
