From the Department of Neurology and Neurological Sciences (V.R., S.C., A.Y., M.M., M.G.L., G.W.A.), Stanford University School of Medicine, CA.
Department of Diagnostic Radiology (G.Z., J.H., M.P.M.), Stanford University School of Medicine, CA.
Stroke. 2019 Mar;50(3):626-631. doi: 10.1161/STROKEAHA.118.023177.
Background and Purpose- Accurate prediction of the subsequent infarct volume early after stroke onset helps determine appropriate interventions and prognosis. In the DEFUSE 3 trial (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke), we evaluated the accuracy of baseline ischemic core and hypoperfusion volumes for predicting infarct volume 24 hours after randomization to endovascular thrombectomy versus medical management. We also assessed if the union of baseline ischemic core and the volume of persistent hypoperfusion at 24 hours after randomization predicts infarct volume. Methods- Patients in DEFUSE 3 with computed tomography perfusion imaging or magnetic resonance diffusion weighted imaging/perfusion imaging acquired at baseline and at 24 hours after randomization were included. Ischemic core and Tmax >6s hypoperfusion volumes at baseline and follow-up were calculated using RAPID software and compared with the infarct volumes obtained 24 hours after randomization. Patients were stratified by reperfusion status for analyses. Results- Of 125 eligible patients, 59 patients with >90% reperfusion had a strong correlation between baseline ischemic core volume and infarct volume 24 hours postrandomization ( r=0.83; P<0.0001), and 14 patients with <10% reperfusion had a strong correlation between baseline Tmax >6s volume and infarct volume 24 hours postrandomization ( r=0.77; P<0.001). In the 52 patients with 10% to 90% reperfusion, as well as in all 125 patients, the union of the baseline ischemic core and the follow-up Tmax >6s perfusion volume was highly correlated with infarct volume 24 hours postrandomization (for N=125; r=0.83; P<0.0001), with a median absolute difference of 21.3 mL between observed and predicted infarct volumes. Conclusions- The union of the irreversibly injured ischemic core and persistently hypoperfused tissue volumes, as identified by computed tomography perfusion or magnetic resonance diffusion weighted imaging/perfusion, predicted infarct volume at 24 hours after randomization in DEFUSE 3 patients. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT02586415.
背景与目的-在卒中发病后早期准确预测梗死体积有助于确定适当的干预措施和预后。在 DEFUSE 3 试验（缺血性卒中血管内治疗后影像学评估）中，我们评估了基线缺血核心和低灌注体积对随机分组后接受血管内血栓切除术与药物治疗的患者 24 小时后梗死体积的预测准确性。我们还评估了随机分组后 24 小时的基线缺血核心和持续低灌注体积之和是否可以预测梗死体积。方法-纳入 DEFUSE 3 中基线和随机分组后 24 小时进行 CT 灌注成像或磁共振弥散加权成像/灌注成像的患者。使用 RAPID 软件计算基线和随访时的缺血核心和 Tmax>6s 低灌注体积，并与随机分组后 24 小时的梗死体积进行比较。对再灌注状态进行分层分析。结果-在 125 例符合条件的患者中，59 例再灌注率>90%的患者，基线缺血核心体积与随机分组后 24 小时梗死体积之间存在很强的相关性（r=0.83；P<0.0001），14 例再灌注率<10%的患者，基线 Tmax>6s 体积与随机分组后 24 小时梗死体积之间存在很强的相关性（r=0.77；P<0.001）。在 52 例再灌注率为 10%至 90%的患者以及所有 125 例患者中，基线缺血核心与随访 Tmax>6s 灌注体积的总和与随机分组后 24 小时梗死体积高度相关（对于 N=125；r=0.83；P<0.0001），观察到的和预测的梗死体积之间的中位数绝对差值为 21.3mL。结论-CT 灌注或磁共振弥散加权成像/灌注成像识别的不可逆性缺血核心和持续低灌注组织体积之和，可预测 DEFUSE 3 患者随机分组后 24 小时的梗死体积。临床试验注册-网址：https://www.clinicaltrials.gov。唯一标识符：NCT02586415。
