Thierfelder K M, Sommer W H, Ertl-Wagner B, Beyer S E, Meinel F G, Kunz W G, Buchholz G, Reiser M F, Janssen H
From the Institute for Clinical Radiology (K.M.T., W.H.S., B.E.-W., S.E.B., F.G.M., W.G.K., M.F.R.)
From the Institute for Clinical Radiology (K.M.T., W.H.S., B.E.-W., S.E.B., F.G.M., W.G.K., M.F.R.).
AJNR Am J Neuroradiol. 2016 Jul;37(7):1296-302. doi: 10.3174/ajnr.A4694. Epub 2016 Feb 11.
The selection of patients for endovascular therapy is an important issue in stroke imaging. The aim of this study was to determine the predictive value of 3 different dynamic CT angiography parameters, occlusion length, collateralization extent, and time delay to maximum enhancement, for latest generation of stent retriever thrombectomy recanalization outcomes in patients with acute ischemic stroke.
In this study, subjects were selected from an initial cohort of 2059 consecutive patients who had undergone multiparametric CT, including whole-brain CT perfusion. We included all patients with a complete occlusion of the M1 segment of the MCA or the carotid T and subsequent intra-arterial stent retriever thrombectomy. Dynamic CT angiography was reconstructed from whole-brain CT perfusion raw datasets. Angiographic outcome was scored by using the modified TICI scale; and clinical outcome, by using the modified Rankin Scale. Logistic regression analyses were performed to determine independent predictors of a favorable angiographic (mTICI = 3) and clinical outcome (mRS ≤2).
Sixty-nine patients (mean age, 68 ± 14 years; 46% men) were included for statistical analysis. In the regression analysis, a short occlusion length was an independent predictor of favorable angiographic outcome (OR, 0.41; P < .05). Both collateralization grade (OR, 1.00; P > .05) and time delay to peak enhancement (OR, 0.90; P > .05) failed to predict a favorable angiographic outcome. None of the dynamic CT angiography predictors were significantly associated with clinical outcome on discharge (OR, 0.664-1.011; P = .330-.953) or at 90 days (OR, 0.779-1.016; P = .130-.845).
A short occlusion length as determined by dynamic CT angiography is an independent predictor of a favorable angiographic outcome of stent retriever thrombectomy in patients with ischemic stroke.
在卒中影像学中，选择接受血管内治疗的患者是一个重要问题。本研究的目的是确定3种不同的动态CT血管造影参数，即闭塞长度、侧支循环程度和最大强化时间延迟，对急性缺血性卒中患者使用新一代支架取栓器进行再通治疗结果的预测价值。
在本研究中，受试者选自最初连续2059例接受多参数CT检查（包括全脑CT灌注）的患者队列。我们纳入了所有大脑中动脉M1段或颈动脉T段完全闭塞并随后接受动脉内支架取栓术的患者。动态CT血管造影由全脑CT灌注原始数据集重建。血管造影结果采用改良的脑梗死溶栓分级（TICI）量表评分；临床结果采用改良的Rankin量表评分。进行逻辑回归分析以确定血管造影良好结果（mTICI = 3）和临床结果（mRS≤2）的独立预测因素。
69例患者（平均年龄68±14岁；46%为男性）纳入统计分析。在回归分析中，较短的闭塞长度是血管造影良好结果的独立预测因素（OR，0.41；P <.05）。侧支循环分级（OR，1.00；P>.05）和最大强化时间延迟（OR，0.90；P>.05）均未能预测血管造影良好结果。动态CT血管造影的预测因素均与出院时（OR，0.664 - 1.011；P =.330 -.953）或90天时（OR，0.779 - 1.016；P =.130 -.845）的临床结果无显著相关性。
动态CT血管造影确定的较短闭塞长度是缺血性卒中患者使用支架取栓器进行血管造影良好结果的独立预测因素。
