Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Cereb Blood Flow Metab. 2021 Jan;41(1):45-52. doi: 10.1177/0271678X20915792. Epub 2020 Apr 4.
The effect of age on lesion pathophysiology in the context of thrombectomy has been poorly investigated. We aimed to investigate the impact of age on ischemic lesion water homeostasis measured with net water uptake (NWU) within a multicenter cohort of patients receiving thrombectomy for anterior circulation large vessel occlusion (LVO) stroke. Lesion-NWU was quantified in multimodal CT on admission and 24 h for calculating Δ-NWU as their difference. The impact of age and procedural parameters on Δ-NWU was analyzed. Multivariable regression analysis was performed to identify significant predictors for Δ-NWU. Two hundred and four patients with anterior circulation stroke were included in the retrospective analysis. Comparison of younger and elderly patients showed no significant differences in NWU on admission but significantly higher Δ-NWU ( = 0.005) on follow-up CT in younger patients. In multivariable regression analysis, higher age was independently associated with lowered Δ-NWU (95% confidence interval: -0.59 to -0.16, < 0.001). Although successful recanalization (TICI ≥ 2b) significantly reduced Δ-NWU progression by 6.4% ( < 0.001), younger age was still independently associated with higher Δ-NWU ( < 0.001). Younger age is significantly associated with increased brain edema formation after thrombectomy for LVO stroke. Younger patients might be particularly receptive targets for future adjuvant neuroprotective drugs that influence ischemic edema formation.
在取栓治疗中，年龄对病灶病理生理学的影响尚未得到充分研究。本研究旨在探讨多中心队列中接受前循环大血管闭塞（LVO）卒中取栓治疗的患者中，年龄对缺血性病灶水稳态的影响，通过净水分摄取（NWU）来衡量。在多模态 CT 上对入院和 24 小时进行病灶-NWU 定量，计算其差值作为Δ-NWU。分析年龄和程序参数对Δ-NWU 的影响。采用多变量回归分析确定Δ-NWU 的显著预测因子。回顾性分析了 204 例前循环卒中患者。对年轻和老年患者进行比较，结果显示两组患者入院时 NWU 无显著差异，但年轻患者在随访 CT 上的Δ-NWU 显著升高（ = 0.005）。多变量回归分析表明，年龄越高，Δ-NWU 越低（95%置信区间：-0.59 至-0.16， < 0.001）。虽然成功再通（TICI≥2b）使Δ-NWU 进展降低 6.4%（ < 0.001），但年龄较低与较高的Δ-NWU 仍独立相关（ < 0.001）。年轻是 LVO 卒中取栓治疗后脑水肿形成增加的显著相关因素。年轻患者可能是未来影响缺血性水肿形成的辅助神经保护药物的特别有吸引力的目标人群。
