血管强化、侧支循环与血管内治疗的脑卒中患者的功能结局。
Hyperintense Vessels, Collateralization, and Functional Outcome in Patients With Stroke Receiving Endovascular Treatment.
机构信息
From the Center for Stroke Research Berlin (A.H.N., A.K., U.G., M. Endres, J.B.F., C.H.N., M. Ebinger), Klinik und Hochschulambulanz für Neurologie (A.H.N., M. Endres, C.H.N.), Institut für Neuroradiologie (E.S., S.K., T.L., J.B.F.), and Department of Biostatistics and Clinical Epidemiology (U.G.), Charité-Universitätsmedizin Berlin, Germany; German Center for Cardiovascular Research (A.H.N., M. Endres,) and German Center for Neurodegenerative Disease (M. Endres), partner site Berlin; Berlin Institute of Health, Germany (A.H.N., M. Endres, C.H.N.); Neurologische Klinik (P.B., H.B.) and Klinik für diagnostische und interventionelle Neuroradiologie (H.H.), Klinikum Stuttgart, Germany; Psychiatrische Universitätsklinik Zürich, Switzerland (P.B.); and Medical Park Berlin Humboldtmühle, Neurologische Klinik, Germany (M. Ebinger).
出版信息
Stroke. 2018 Mar;49(3):675-681. doi: 10.1161/STROKEAHA.117.019588. Epub 2018 Feb 19.
BACKGROUND AND PURPOSE
Fluid-attenuated inversion recovery hyperintense vessels (FHV) are frequently observed on magnetic resonance imaging in acute stroke patients with proximal vessel occlusion. Whether FHV can serve as a surrogate for the collateral status and predict functional outcome of patients is still a matter of debate.
METHODS
Acute ischemic stroke patients with M1-middle cerebral artery occlusion who received magnetic resonance imaging before endovascular treatment in 3 hospitals in Germany between January 2007 and June 2016 were eligible. Quantification of FHV was performed using an FHV-Alberta Stroke Program Early CT Score (ASPECTS) rating system. Functional outcome was evaluated with the modified Rankin Scale 3 months after stroke. Collateral status of patients was graded on baseline angiography using the American Society of Interventional and Therapeutic Neuroradiology grading system. Odds for good outcome (modified Rankin Scale score, 0-2) were determined using logistic regression analyses.
RESULTS
Overall, 116 patients were analyzed (median age, 74; interquartile range [IQR], 64-79; median National Institutes of Health Stroke Scale, 14; IQR, 10-19). The median FHV-ASPECTS was 2 (IQR, 1-3). Good collateral status (American Society of Interventional and Therapeutic Neuroradiology grade 3-4) on angiography was more frequently observed in patients with FHV-ASPECTS ≤2 (83% versus 57%; =0.025). Patients with an FHV-ASPECTS ≤2 had a better functional outcome after 3 months (median modified Rankin Scale score, 2; IQR, 0-5), compared with patients with an FHV-ASPECTS >2 (median modified Rankin Scale score, 4; IQR, 3-6; =0.015). In multiple regression analyses, FHV-ASPECTS ≤2 was independently associated with good functional outcome (adjusted odds ratio, 5.3; 95% confidence interval, 1.5-18.2).
CONCLUSIONS
Low FHV-ASPECTS is associated with both better collateral status and better 3-month functional outcome in acute stroke patients with M1 vessel occlusion.
背景与目的
在近端血管闭塞的急性脑卒中患者的磁共振成像中，经常观察到液体衰减反转恢复高信号血管（FHV）。FHV 是否可以作为侧支状态的替代指标，并预测患者的功能结局，仍然存在争议。
方法
在 2007 年 1 月至 2016 年 6 月期间，德国 3 家医院接受血管内治疗前的 M1 大脑中动脉闭塞的急性缺血性脑卒中患者符合入选标准。使用 FHV-阿尔伯塔卒中计划早期 CT 评分（ASPECTS）评分系统对 FHV 进行量化。用改良 Rankin 量表（mRS）在卒中后 3 个月评估功能结局。用美国介入治疗神经放射学学会（ASITN）分级系统在基线血管造影上对患者的侧支状态进行分级。用 logistic 回归分析确定良好结局（mRS 评分 0-2）的几率。
结果
共分析了 116 例患者（中位年龄 74 岁，四分位距 [IQR] 64-79 岁；中位 NIHSS 评分 14 分，IQR 10-19 分）。FHV-ASPECTS 的中位数为 2 分（IQR 1-3 分）。在血管造影上，侧支状态良好（ASITN 分级 3-4 级）的患者中，FHV-ASPECTS ≤2 的比例更高（83%比 57%；=0.025）。FHV-ASPECTS ≤2 的患者 3 个月后的功能结局更好（中位 mRS 评分 2 分，IQR 0-5 分），而 FHV-ASPECTS＞2 的患者（中位 mRS 评分 4 分，IQR 3-6 分；=0.015）。在多元回归分析中，FHV-ASPECTS ≤2 与良好的功能结局独立相关（调整后的比值比 5.3，95%置信区间 1.5-18.2）。
结论
在 M1 血管闭塞的急性脑卒中患者中，低 FHV-ASPECTS 与更好的侧支状态和 3 个月时更好的功能结局相关。
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