Chung Jong-Won, Kim Jun Yup, Park Hong-Kyun, Kim Beom Joon, Han Moon-Ku, Lee Jun, Choi Kang-Ho, Kim Joon-Tae, Jung Cheolkyu, Kim Jae Hyoung, Kwon O-Ki, Oh Chang Wan, Lee Juneyoung, Bae Hee-Joon
Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Neurology, Stroke Center, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, Republic of Korea.
J Stroke Cerebrovasc Dis. 2017 Feb;26(2):360-367. doi: 10.1016/j.jstrokecerebrovasdis.2016.09.031. Epub 2016 Oct 25.
In patients with acute ischemic stroke, the impact of penumbral patterns on clinical outcomes after endovascular treatment (EVT) remains controversial. We aimed to establish whether penumbral patterns are associated with clinical outcome after successful recanalization with EVT while adjusting for onset to revascularization time.
Using a web-based, multicenter, prospective stroke registry database, we identified patients with acute ischemic stroke who underwent perfusion and diffusion magnetic resonance imaging (MRI) before EVT, had anterior circulation stroke, received EVT within 12 hours of symptom onset, and had successful revascularization confirmed during EVT. Based on pretreatment MRI, patients were stratified as having a favorable or nonfavorable penumbral pattern. Onset to revascularization time was dichotomized by median value. Primary outcome was functional independence (modified Rankin Scale score ≤2) at 90 days.
Among 121 eligible patients from three university hospitals, 104 (86.0%) had a favorable penumbral pattern, and the median time to revascularization was 271 minutes (interquartile range, 196-371). The functionally independent patient proportion was higher in those with a favorable penumbral pattern than in those without (53.8% versus 5.9%; P <.001), but was not different between early and late revascularization groups (49.2% versus 45.0%; P = .65). The favorable penumbral pattern was associated with functional independence after adjusting confounders (odds ratio, 23.25; 95% confidence interval: 1.58-341.99; P = .02). Time to revascularization did not modify the association (P for interaction, .53).
A favorable penumbral pattern is associated with improved functional independence in patients with endovascular revascularization, and the association was not time-dependent.
在急性缺血性脑卒中患者中，半暗带模式对血管内治疗（EVT）后临床结局的影响仍存在争议。我们旨在确定在调整从发病到血管再通时间的情况下，半暗带模式是否与EVT成功再通后的临床结局相关。
利用基于网络的多中心前瞻性卒中登记数据库，我们纳入了急性缺血性脑卒中患者，这些患者在接受EVT前接受了灌注和弥散磁共振成像（MRI）检查，患有前循环卒中，在症状发作后12小时内接受了EVT，并且在EVT期间确认血管再通成功。根据治疗前MRI，将患者分为半暗带模式良好或不良。从发病到血管再通时间按中位数进行二分法划分。主要结局是90天时的功能独立性（改良Rankin量表评分≤2）。
在来自三家大学医院的121例符合条件的患者中，104例（86.0%）半暗带模式良好，血管再通的中位时间为271分钟（四分位间距，196 - 371）。半暗带模式良好的患者中功能独立的患者比例高于半暗带模式不良的患者（53.8%对5.9%；P <.001），但早期和晚期血管再通组之间无差异（49.2%对45.0%；P = 0.65）。在调整混杂因素后，良好的半暗带模式与功能独立性相关（比值比，23.25；95%置信区间：1.58 - 341.99；P = 0.02）。血管再通时间并未改变这种关联（交互作用P值，0.53）。
良好的半暗带模式与血管内再通患者功能独立性的改善相关，且这种关联不依赖时间。
