Tisserand Marie, Turc Guillaume, Charron Sylvain, Legrand Laurence, Edjlali Myriam, Seners Pierre, Roca Pauline, Lion Stéphanie, Naggara Olivier, Mas Jean-Louis, Méder Jean-François, Baron Jean-Claude, Oppenheim Catherine
From the Departments of Radiology (M.T., S.C., L.L., M.E., P.R., S.L., O.N., J.-F.M., C.O.) and Neurology (G.T., P.S., J.-L.M., J.-C.B.), Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France.
Stroke. 2016 Apr;47(4):1005-11. doi: 10.1161/STROKEAHA.115.012518. Epub 2016 Mar 15.
Whether to withhold recanalization treatment when the diffusion-weighted imaging (DWI) lesion exceeds a given volume is unsettled. Our aim was to assess the impact of recanalization on outcome in patients with baseline DWI lesion ≥70 mL (DWI≥70 mL) treated ≤4.5 hours from onset. We hypothesized that recanalization is beneficial in a sizeable fraction of these patients and that this is associated with a larger DWI lesion reversal.
We analyzed 267 consecutive patients treated with intravenous recombinant tissue-type plasminogen activator for middle cerebral artery territory stroke in whom an occlusion was present on magnetic resonance angiography and 24-hour recanalization and 90-day clinical outcome could be assessed. After stratification relative to the 70-mL DWI lesion cut point, we calculated the odds ratio for recanalization of the primary arterial occlusive lesion (AOL score ≥2) to predict favorable outcome (modified Rankin scale score ≤2). DWI lesion reversal was compared between recanalizers with DWI≥70 mL with favorable and unfavorable outcomes.
Median (interquartile range) DWI lesion volume was 22 mL (10-60), and median onset time to imaging was 116 minutes (86-151). Twelve (22%) of the 54 patients with DWI≥70 mL experienced favorable outcome, of which 9 had recanalized. In patients with DWI≥70 mL, recanalization was significantly associated with favorable outcome after adjustment for age and National Institutes of Health Stroke Scale (odds ratio =4.72 [1.09-20.32]; P=0.0375). Among recanalizers with DWI≥70 mL, absolute and relative DWI reversal volumes were larger in those with favorable as compared with unfavorable outcome (18.8 mL [12.2-47.6] versus 8.5 mL [4.3-31.1]; P=0.17; and 19.6% [10.9-62.8] versus 8.7% [3.9-16.5], respectively; P=0.049).
Patients with DWI lesion volume ≥70 mL can benefit from recanalization after intravenous recombinant tissue-type plasminogen activator. This may partly reflect a larger amount of DWI lesion reversal.
当扩散加权成像（DWI）病变超过给定体积时是否停止再通治疗尚无定论。我们的目的是评估在发病≤4.5小时接受治疗的基线DWI病变≥70 mL（DWI≥70 mL）患者中，再通对预后的影响。我们假设在这些患者中有相当一部分可从再通中获益，且这与更大的DWI病变逆转相关。
我们分析了267例连续接受静脉注射重组组织型纤溶酶原激活剂治疗的大脑中动脉区域卒中患者，这些患者在磁共振血管造影上存在闭塞，且可评估24小时再通情况和90天临床预后。在相对于70 mL DWI病变切点进行分层后，我们计算了主要动脉闭塞病变再通（AOL评分≥2）预测良好预后（改良Rankin量表评分≤2）的比值比。比较了DWI≥70 mL且预后良好和不良的再通者之间的DWI病变逆转情况。
DWI病变体积的中位数（四分位间距）为22 mL（10 - 60），成像的中位发病时间为116分钟（86 - 151）。54例DWI≥70 mL的患者中有12例（22%）预后良好，其中9例实现了再通。在DWI≥70 mL的患者中，在调整年龄和美国国立卫生研究院卒中量表后，再通与良好预后显著相关（比值比 = 4.72 [1.09 - 20.32]；P = 0.0375）。在DWI≥70 mL的再通者中，预后良好者与预后不良者相比，DWI绝对和相对逆转体积更大（分别为18.8 mL [12.2 - 47.6] 与8.5 mL [4.3 - 31.1]；P = 0.17；以及19.6% [10.9 - 62.8] 与8.7% [3.9 - 16.5]，P = 0.049）。
DWI病变体积≥70 mL的患者在静脉注射重组组织型纤溶酶原激活剂后可从再通中获益。这可能部分反映了更大程度的DWI病变逆转。
