Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Clinical Radiology, University Hospital Münster, Münster, Germany.
Brain. 2019 May 1;142(5):1399-1407. doi: 10.1093/brain/awz057.
The impact of endovascular vessel recanalization on patients with a low initial Alberta Stroke Program Early Computer Tomography Score (ASPECTS) is still uncertain. We hypothesized that vessel recanalization leads to an improvement in mortality and degree of disability by reducing brain oedema and malignant mass effect. In this multicentre observational study, patients with acute ischaemic stroke due to large vessel occlusion in the anterior circulation and an ASPECTS of ≤ 5 were analysed. Patients were assembled into two groups: successful vessel recanalization (thrombolysis in cerebral infarctions, TICI scale 2b/3) or persistent vessel occlusion (no endovascular procedure or TICI scale 0-2a). Observers were blinded to clinical data. Net water uptake within brain infarct, a quantitative biomarker based on CT densitometry, was used to quantify oedema in admission and follow-up CT and Δ-water uptake was calculated as difference between water uptake at both time points. Occurrence of malignant infarctions and secondary parenchymal haemorrhage was documented. Furthermore, modified Rankin scale score at 90 days was used for functional outcome. We included 117 patients admitted between March 2015 and August 2017 in three German stroke centres: 71 with persistent vessel occlusion and 46 with successful recanalization. The mean water uptake in the admission imaging was not different between both groups: 10.0% (±4.8) in patients with persistent vessel occlusion and 9.0% (±4.8) in patients with vessel recanalization (P = 0.4). After follow-up CT, the mean Δ-water uptake was 16.0% (±7.5) in patients with persistent vessel occlusion and 8.0% (±5.7) in patients with vessel recanalization (P < 0.001). Successful reperfusion was independently associated with a lowered Δ-water uptake of 8.0% (95% confidence interval, CI: -10.5 to -5.3%; P < 0.001) and lowered modifed Rankin scale score after 90 days of 1.5 (95% CI: -2.2 to -0.8; P < 0.001). The prevalence of malignant infarctions was 44.3% in patients with persistent vessel occlusion and 26.1% in patients with vessel recanalization. There was no significant difference for secondary haemorrhage in both groups (P = 0.7). In conclusion, successful recanalization in patients with low initial ASPECTS resulted in a significant reduction of oedema formation and was associated with a decreased prevalence of malignant infarctions and an improvement of clinical outcome.
血管内血管再通对初始 Alberta 卒中项目早期计算机断层扫描评分（ASPECTS）较低的患者的影响仍不确定。我们假设血管再通通过减少脑水肿和恶性肿块效应，导致死亡率和残疾程度的改善。在这项多中心观察性研究中，分析了因前循环大血管闭塞和 ASPECTS≤5 导致急性缺血性卒中的患者。将患者分为两组：血管再通成功（血栓溶解治疗脑梗死，TICI 分级 2b/3）或血管持续闭塞（无血管内治疗或 TICI 分级 0-2a）。观察者对临床数据不知情。基于 CT 密度测定的定量生物标志物净水摄取用于量化入院和随访 CT 中的水肿，计算水摄取的差异作为两个时间点之间的差异。记录恶性梗死和继发性实质内出血的发生。此外，90 天时的改良 Rankin 量表评分用于评估功能结局。我们纳入了 2015 年 3 月至 2017 年 8 月在三个德国卒中中心收治的 117 例患者：71 例持续性血管闭塞和 46 例血管再通成功。两组入院时的平均水摄取量无差异：持续性血管闭塞患者为 10.0%（±4.8），血管再通患者为 9.0%（±4.8）（P=0.4）。在随访 CT 后，持续性血管闭塞患者的平均Δ水摄取为 16.0%（±7.5），血管再通患者为 8.0%（±5.7）（P＜0.001）。成功再灌注与降低 8.0%的Δ水摄取（95%置信区间，CI：-10.5 至-5.3%；P＜0.001）和 90 天后改良 Rankin 量表评分降低 1.5 分（95%CI：-2.2 至-0.8；P＜0.001）独立相关。持续性血管闭塞患者的恶性梗死发生率为 44.3%，血管再通患者为 26.1%。两组间继发性出血无显著差异（P=0.7）。总之，在初始 ASPECTS 较低的患者中成功再通可显著减少水肿形成，并降低恶性梗死的发生率和改善临床结局。
