Lansberg Maarten G, Christensen Soren, Kemp Stephanie, Mlynash Michael, Mishra Nishant, Federau Christian, Tsai Jenny P, Kim Sun, Nogueria Raul G, Jovin Tudor, Devlin Thomas G, Akhtar Naveed, Yavagal Dileep R, Haussen Diogo, Dehkharghani Seena, Bammer Roland, Straka Matus, Zaharchuk Greg, Marks Michael P, Albers Gregory W
Department of Neurology, Stanford University, Stanford, CA.
Department of Neurology, Emory University, Atlanta, GA.
Ann Neurol. 2017 Jun;81(6):849-856. doi: 10.1002/ana.24953. Epub 2017 Jun 9.
To assess the utility of computed tomographic (CT) perfusion for selection of patients for endovascular therapy up to 18 hours after symptom onset.
We conducted a multicenter cohort study of consecutive acute stroke patients scheduled to undergo endovascular therapy within 90 minutes after a baseline CT perfusion. Patients were classified as "target mismatch" if they had a small ischemic core and a large penumbra on their baseline CT perfusion. Reperfusion was defined as >50% reduction in critical hypoperfusion between the baseline CT perfusion and the 36-hour follow-up magnetic resonance imaging.
Of the 201 patients enrolled, 190 patients with an adequate baseline CT perfusion study who underwent angiography were included (mean age = 66 years, median NIH Stroke Scale [NIHSS] = 16, median time from symptom onset to endovascular therapy = 5.2 hours). Rate of reperfusion was 89%. In patients with target mismatch (n = 131), reperfusion was associated with higher odds of favorable clinical response, defined as an improvement of ≥8 points on the NIHSS (83% vs 44%; p = 0.002, adjusted odds ratio [OR] = 6.6, 95% confidence interval [CI] = 2.1-20.9). This association did not differ between patients treated within 6 hours (OR = 6.4, 95% CI = 1.5-27.8) and those treated > 6 hours after symptom onset (OR = 13.7, 95% CI = 1.4-140).
The robust association between endovascular reperfusion and good outcome among patients with the CT perfusion target mismatch profile treated up to 18 hours after symptom onset supports a randomized trial of endovascular therapy in this patient population. Ann Neurol 2017;81:849-856.
评估计算机断层扫描（CT）灌注成像在症状发作后18小时内选择接受血管内治疗患者中的应用价值。
我们对一系列急性卒中患者进行了一项多中心队列研究，这些患者在基线CT灌注成像后90分钟内计划接受血管内治疗。如果患者在基线CT灌注成像时有小的缺血核心和大的半暗带，则被分类为“目标不匹配”。再灌注定义为基线CT灌注成像与36小时随访磁共振成像之间严重灌注不足减少>50%。
在纳入的201例患者中，190例有充分基线CT灌注研究且接受了血管造影的患者被纳入分析（平均年龄=66岁，美国国立卫生研究院卒中量表[NIHSS]中位数=16，症状发作至血管内治疗的中位数时间=5.2小时）。再灌注率为89%。在目标不匹配的患者（n=131）中，再灌注与良好临床反应的较高几率相关，良好临床反应定义为NIHSS改善≥8分（83%对44%；p=0.002，调整优势比[OR]=6.6，95%置信区间[CI]=2.1-20.9）。在症状发作后6小时内接受治疗的患者（OR=6.4，95%CI=1.5-27.8）和症状发作后>6小时接受治疗的患者（OR=13.7，95%CI=1.4-140）之间，这种关联没有差异。
在症状发作后18小时内接受治疗的CT灌注目标不匹配患者中，血管内再灌注与良好结局之间的紧密关联支持对该患者群体进行血管内治疗的随机试验。《神经病学纪要》2017年；81:849-856。
