Guenego A, Fahed R, Albers G W, Kuraitis G, Sussman E S, Martin B W, Marcellus D G, Olivot J-M, Marks M P, Lansberg M G, Wintermark M, Heit J J
Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Stanford, CA, USA.
Department of Medicine, Division of Neurology, Ottawa Hospital, Ottawa, ON, Canada.
Eur J Neurol. 2020 May;27(5):864-870. doi: 10.1111/ene.14181. Epub 2020 Mar 13.
Among patients with an acute ischaemic stroke secondary to large-vessel occlusion, the hypoperfusion intensity ratio (HIR) [time to maximum (TMax) > 10 volume/TMax > 6 volume] is a strong predictor of infarct growth. We studied the correlation between HIR and collaterals assessed with digital subtraction angiography (DSA) before thrombectomy.
Between January 2014 and March 2018, consecutive patients with an acute ischaemic stroke and an M1 middle cerebral artery (MCA) occlusion who underwent perfusion imaging and endovascular treatment at our center were screened. Ischaemic core (mL), HIR and perfusion mismatch (TMax > 6 s minus core volume) were assessed through magnetic resonance imaging or computed tomography perfusion. Collaterals were assessed on pre-intervention DSA using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) scale. Baseline clinical and perfusion characteristics were compared between patients with good (ASITN/SIR score 3-4) and those with poor (ASITN/SIR score 0-2) DSA collaterals. Correlation between HIR and ASITN/SIR scores was evaluated using Pearson's correlation. Receiver operating characteristic analysis was performed to determine the optimal HIR threshold for the prediction of good DSA collaterals.
A total of 98 patients were included; 49% (48/98) had good DSA collaterals and these patients had significantly smaller hypoperfusion volumes (TMax > 6 s, 89 vs. 125 mL; P = 0.007) and perfusion mismatch volumes (72 vs. 89 mL; P = 0.016). HIR was significantly correlated with DSA collaterals (-0.327; 95% confidence interval, -0.494 to -0.138; P = 0.01). An HIR cut-off of <0.4 best predicted good DSA collaterals with an odds ratio of 4.3 (95% confidence interval, 1.8-10.1) (sensitivity, 0.792; specificity, 0.560; area under curve, 0.708).
The HIR is a robust indicator of angiographic collaterals and might be used as a surrogate of collateral assessment in patients undergoing magnetic resonance imaging. HIR <0.4 best predicted good DSA collaterals.
在继发于大血管闭塞的急性缺血性卒中患者中，低灌注强度比（HIR）[最大时间（TMax）>10容积/TMax>6容积]是梗死灶扩大的有力预测指标。我们研究了HIR与血栓切除术前行数字减影血管造影（DSA）评估的侧支循环之间的相关性。
筛选2014年1月至2018年3月间在本中心接受灌注成像和血管内治疗的急性缺血性卒中和大脑中动脉M1段闭塞的连续患者。通过磁共振成像或计算机断层扫描灌注评估缺血核心（毫升）、HIR和灌注不匹配（TMax>6秒减去核心容积）。使用美国介入和治疗神经放射学会/介入放射学会（ASITN/SIR）量表在干预前DSA上评估侧支循环。比较DSA侧支循环良好（ASITN/SIR评分3-4）和不良（ASITN/SIR评分0-2）患者的基线临床和灌注特征。使用Pearson相关性评估HIR与ASITN/SIR评分之间的相关性。进行受试者操作特征分析以确定预测良好DSA侧支循环的最佳HIR阈值。
共纳入98例患者；49%（48/98）患者DSA侧支循环良好，这些患者的低灌注容积（TMax>6秒，89对125毫升；P=0.007）和灌注不匹配容积（72对89毫升；P=0.016）明显较小。HIR与DSA侧支循环显著相关（-0.327；95%置信区间，-0.494至-0.138；P=0.01）。HIR临界值<0.4对良好DSA侧支循环的预测最佳，优势比为4.3（95%置信区间，1.8-10.1）（敏感性，0.792；特异性，0.560；曲线下面积，0.708）。
HIR是血管造影侧支循环的可靠指标，可作为接受磁共振成像患者侧支循环评估的替代指标。HIR<0.4对良好DSA侧支循环的预测最佳。
