作为存活脑组织标志物的毛细血管指数评分：概念验证——荷兰急性缺血性卒中血管内治疗多中心随机临床试验（MR CLEAN）中的毛细血管指数评分
The Capillary Index Score as a Marker of Viable Cerebral Tissue: Proof of Concept-The Capillary Index Score in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Trial.
作者信息
Al-Ali Firas, Berkhemer Olvert A, Yousman Wina P, Elias John J, Bender Evin N, Lingsma Hester F, van der Lugt Aad, Dippel Diederik W J, Roos Yvo B W E M, van Oostenbrugge Robert J, van Zwam Wim H, Dillon William P, Majoie Charles B L M
机构信息
From the Departments of Neuro Interventional Surgery (F.A.-A.) and Research (W.P.Y., J.J.E.), Cleveland Clinic Akron General, Akron, OH; Departments of Radiology (O.A.B., C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Medicine, Northeast Ohio Medical University, Rootstown (E.N.B.); Departments of Neurology (O.A.B., D.W.J.D., W.v.Z.), Public Health (H.F.L.), and Radiology (A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Departments of Radiology (O.A.B.) and Neurology (R.J.v.O.), Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands; and Department of Radiology, University of California San Francisco (W.P.D.).
出版信息
Stroke. 2016 Sep;47(9):2286-91. doi: 10.1161/STROKEAHA.116.013513. Epub 2016 Aug 4.
BACKGROUND AND PURPOSE
The capillary index score (CIS) is based on the hypothesis that areas lacking capillary blush on pretreatment cerebral digital subtraction angiograms correspond to nonviable cerebral tissue.
METHODS
Pretreatment digital subtraction angiograms and post-treatment noncontrast enhanced computed tomographic scans from the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) trial were evaluated for areas lacking capillary blush and with tissue hypodensity, respectively. Because the superior and middle zones of the CIS correspond to the 7 cerebral cortex regions of the Alberta Stroke Program Early CT (ASPECT) score, capillary blush was scored in these 2 zones (0-2), called sub-CIS, and compared with the ASPECT score in these 7 regions (0-7), called hypodensity score. The presence and extent of hypodensity were compared between sub-CIS zones with contingency tables and nonparametric comparisons between groups, respectively.
RESULTS
On the basis of a sample size of 50 subjects, 100% with sub-CIS <2 had the presence of hypodensity (hypodensity score ≥1) versus 57% for sub-CIS=2 (P=0.004). The extent of hypodensity (numeric hypodensity score) was significantly lower for sub-CIS=2 than 0 or 1 (P=0.02). For 42 subjects with revascularization data, the presence and extent of hypodensity were significantly lower for sub-CIS=2 plus good revascularization than for other combinations of sub-CIS and revascularization (P=0.02 and 0.01, respectively).
CONCLUSIONS
The absence of capillary blush on pretreatment digital subtraction angiogram seems to correspond to nonviable cerebral tissue. Successful revascularization reduces the chance of tissue hypodensity (infarction), when capillary blush is present.
CLINICAL TRIAL REGISTRATION
URL: http://www.trialregister.nl. Unique identifier: NTR number 1804. URL: http://www.isrctn.com. Unique identifier: ISRCTN10888758.
背景与目的
毛细血管指数评分（CIS）基于这样一种假设，即治疗前脑数字减影血管造影中缺乏毛细血管充盈的区域对应于无活力的脑组织。
方法
分别对来自荷兰急性缺血性卒中血管内治疗多中心随机临床试验（MR CLEAN）的治疗前数字减影血管造影和治疗后非增强计算机断层扫描进行评估，以确定缺乏毛细血管充盈的区域和组织低密度区域。由于CIS的上部和中部区域对应于阿尔伯塔卒中项目早期CT（ASPECT）评分的7个脑皮质区域，因此在这两个区域（0 - 2）对毛细血管充盈进行评分，称为亚CIS，并与这7个区域（0 - 7）的ASPECT评分（称为低密度评分）进行比较。分别使用列联表和组间非参数比较来比较亚CIS区域之间低密度的存在情况和范围。
结果
基于50名受试者的样本量，亚CIS <2的受试者中100%存在低密度（低密度评分≥1），而亚CIS = 2的受试者中这一比例为57%（P = 0.004）。亚CIS = 2时低密度的范围（数字低密度评分）显著低于亚CIS = 0或1时（P = 0.02）。对于42名有血管再通数据的受试者，亚CIS = 2且血管再通良好时，低密度的存在情况和范围显著低于亚CIS与血管再通的其他组合（分别为P = 0.02和0.01）。
结论
治疗前数字减影血管造影中无毛细血管充盈似乎对应于无活力的脑组织。当存在毛细血管充盈时，成功的血管再通可降低组织低密度（梗死）的几率。
临床试验注册
网址：http://www.trialregister.nl。唯一标识符：NTR编号1804。网址：http://www.isrctn.com。唯一标识符：ISRCTN10888758。
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