Division of Neurology, Neuroscience Institute, Spectrum Health, Grand Rapids, MI.
Michgan State University, East Lansing, MI.
J Neuroimaging. 2020 May;30(3):315-320. doi: 10.1111/jon.12698. Epub 2020 Feb 18.
Recent trials have shown benefit of thrombectomy in patients selected by penumbral imaging in the late (>6 hours) window. However, the role penumbral imaging is not clear in the early (0-6 hours) window. We sought to evaluate if time to treatment modifies the effect of endovascular reperfusion in stroke patients with evidence of salvageable tissue on CT perfusion (CTP).
We retrospectively analyzed consecutive patients who underwent thrombectomy in a single center. Demographics, comorbidities, National Institute of Health Stroke Scale (NIHSS), rtPA administration, ASPECTS, core infarct volume, onset to skin puncture time, recanalization (mTICI IIb/III), final infarct volume were compared between patients with good and poor 90-day outcomes (mRS 0-2 vs. 3-6). Multivariable logistic regression analyses were used to identify independent predictors of a good (mRS 0-2) 90-day outcome.
A total of 235 patients were studied, out of which 52.3% were female. Univariate analysis showed that the groups (early vs. late) were balanced for age (P = .23), NIHSS (P = .63), vessel occlusion location (P = .78), initial core infarct volume (P = .15), and recanalization (mTICI IIb/III) rates (P = .22). Favorable outcome (mRS 0-2) at 90 days (P = .30) were similar. There was a significant difference in final infarct volume (P = .04). Shift analysis did not reveal any significant difference in 90-day outcome (P = .14). After adjustment; age (P < .001), NIHSS (P = .01), recanalization (P = .008), and final infarct volume (P < .001) were predictive of favorable outcome.
Penumbral imaging-based selection of patients for thrombectomy is effective regardless of onset time and yields similar functional outcomes in early and late window patients.
最近的试验表明，在选择通过缺血半暗带成像（penumbral imaging）进行治疗的患者中，在晚期（>6 小时）时间窗内进行血栓切除术是有益的。然而，在早期（0-6 小时）时间窗内，缺血半暗带成像的作用尚不清楚。我们旨在评估 CT 灌注（CTP）显示有可挽救组织的卒中患者，治疗时间是否会改变血管内再灌注治疗的效果。
我们回顾性分析了在单中心接受血栓切除术的连续患者。比较了患者的人口统计学资料、合并症、国立卫生研究院卒中量表（NIHSS）评分、rtPA 给药、ASPECTS、核心梗死体积、发病至皮肤穿刺时间、再通（mTICI IIb/III）、最终梗死体积，这些因素在 90 天预后良好（mRS 0-2）和预后不良（mRS 3-6）的患者之间进行了比较。采用多变量逻辑回归分析确定 90 天预后良好（mRS 0-2）的独立预测因素。
共研究了 235 例患者，其中 52.3%为女性。单因素分析显示，早期组和晚期组在年龄（P=0.23）、NIHSS（P=0.63）、血管闭塞部位（P=0.78）、初始核心梗死体积（P=0.15）和再通率（mTICI IIb/III）（P=0.22）方面无差异。90 天预后良好（mRS 0-2）的比例（P=0.30）相似。最终梗死体积有显著差异（P=0.04）。转移分析显示 90 天的预后无显著差异（P=0.14）。调整后，年龄（P<0.001）、NIHSS（P=0.01）、再通（P=0.008）和最终梗死体积（P<0.001）是良好预后的预测因素。
基于缺血半暗带成像的患者选择进行血栓切除术，无论发病时间如何，在早期和晚期时间窗患者中均能产生相似的功能结局。
