Deng Wenjing, Teng Junfang, Liebeskind David, Miao Wang, Du Ran
Neurointensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Neurointensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
World Neurosurg. 2019 Mar;123:e797-e802. doi: 10.1016/j.wneu.2018.12.051. Epub 2018 Dec 24.
The infarct volume is associated with the clinical outcome after ischemic stroke. We investigated the factors associated with infarct growth and its effect on functional outcome in patients with acute ischemic stroke.
The present retrospective study included 158 patients with acute ischemic stroke receiving endovascular treatment at the University of California, Los Angeles, Medical Center from 2011 to 2016. The patients' clinical parameters were collected. Magnetic resonance imaging was performed before treatment and 24 hours after endovascular treatment to calculate the infarct volume. The infarct sizes were measured using apparent diffusion coefficient maps. The modified Rankin scale (mRS) scores at discharge and 90 days after discharge were used to evaluate the functional outcomes. An mRS score of 0-2 was defined as a good outcome. The predictors of infarct growth and mRS score at 90 days were analyzed using regression analysis.
Patients with smaller infarct growth had significantly better clinical outcomes as measured by the mRS score at discharge and at 90 days and mortality at 90 days (P < 0.001). Infarct growth of 12.11 cm was defined as the optimal cutoff to predict the clinical outcome using the receiver operating characteristic curve. The baseline Alberta Stroke Program Early CT (computed tomography) score (odds ratio [OR], 0.8; 95% confidence interval [CI], 0.665-0.962; P = 0.017) and modified thrombolysis in cerebral infarction score (OR, 0.259; 95% CI, 0.120-0.559; P = 0.001) were independent factors that predicted for infarct growth. Infarct growth (OR, 1.044; 95% CI, 1.024-1.064; P < 0.001) and baseline National Institutes of Health stroke scale score (OR, 1.070; 95% CI, 1.008-1.136; P = 0.027) were independent factors that predicted the mRS score at 90 days.
Infarct growth was associated with the functional outcome. Smaller infarct growth correlated with better outcomes. A greater Alberta Stroke Program Early CT score and better perfusion predicted for smaller infarct growth.
梗死体积与缺血性卒中后的临床结局相关。我们研究了急性缺血性卒中患者梗死灶扩大的相关因素及其对功能结局的影响。
本回顾性研究纳入了2011年至2016年在加利福尼亚大学洛杉矶分校医学中心接受血管内治疗的158例急性缺血性卒中患者。收集患者的临床参数。在治疗前及血管内治疗后24小时进行磁共振成像以计算梗死体积。使用表观扩散系数图测量梗死灶大小。出院时及出院后90天的改良Rankin量表（mRS）评分用于评估功能结局。mRS评分为0 - 2被定义为良好结局。采用回归分析梗死灶扩大及90天时mRS评分的预测因素。
梗死灶扩大较小的患者，出院时及90天时的mRS评分及90天时的死亡率所衡量的临床结局显著更好（P < 0.001）。使用受试者工作特征曲线将梗死灶扩大12.11 cm定义为预测临床结局的最佳截断值。基线阿尔伯塔卒中项目早期CT（计算机断层扫描）评分（比值比[OR]，0.8；95%置信区间[CI]，0.665 - 0.962；P = 0.017）和改良脑梗死溶栓评分（OR，0.259；95% CI，0.120 - 0.559；P = 0.001）是预测梗死灶扩大的独立因素。梗死灶扩大（OR，1.044；95% CI，1.024 - 1.064；P < 0.001）和基线美国国立卫生研究院卒中量表评分（OR, 1.070；95% CI，1.008 - 1.136；P = 0.027）是预测90天时mRS评分的独立因素。
梗死灶扩大与功能结局相关。梗死灶扩大较小与更好的结局相关。更高的阿尔伯塔卒中项目早期CT评分及更好的灌注预示梗死灶扩大较小。
