Department of Neurology ad Stroke Senter, Samsung Medical Center & Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea (W.-K.S.).
Department of Neurology and Comprehensive Stroke Center (D.S.L., L.S., M.N., S.S., N.R., M.B.H., J.L.S.), UCLA, Los Angeles, CA.
Stroke. 2020 Aug;51(8):2553-2557. doi: 10.1161/STROKEAHA.120.030010. Epub 2020 Jul 2.
We aimed to delineate the determinants of the initial speed of infarct progression and the association of speed of infarct progression (SIP) with procedural and functional outcomes.
From a prospectively maintained stroke center registry, consecutive anterior circulation ischemic stroke patients with large artery occlusion, National Institutes of Health Stroke Scale score ≥4, and multimodal vessel, ischemic core, and tissue-at-risk imaging within 24 hours of onset were included. Initial SIP was calculated as ischemic core volume at first imaging divided by the time from stroke onset to imaging.
Among the 88 patients, SIP was median 2.2 cc/h (interquartile range, 0-8.7), ranging most widely within the first 6 hours after onset. Faster SIP was positively independently associated with a low collateral score (odds ratio [OR], 3.30 [95% CI, 1.25-10.49]) and arrival by emergency medical services (OR, 3.34 [95% CI, 1.06-10.49]) and negatively associated with prior ischemic stroke (OR, 0.12 [95% CI, 0.03-0.50]) and coronary artery disease (OR, 0.32 [95% CI, 0.10-1.00]). Among the 67 patients who underwent endovascular thrombectomy, slower SIP was associated with a shift to reduced levels of disability at discharge (OR, 3.26 [95% CI, 1.02-10.45]), increased substantial reperfusion by thrombectomy (OR, 8.30 [95% CI, 0.97-70.87]), and reduced radiological hemorrhagic transformation (OR, 0.34 [95% CI, 0.12-0.94]).
Slower SIP is associated with a high collateral score, prior ischemic stroke, and coronary artery disease, supporting roles for both collateral robustness and ischemic preconditioning in fostering tissue resilience to ischemia. Among patients undergoing endovascular thrombectomy, the speed of infarct progression is a major determinant of clinical outcome.
本研究旨在描述梗死进展初始速度的决定因素，以及速度与程序和功能结局的关系。
从一个前瞻性维护的卒中中心注册处，纳入了连续的前循环缺血性卒中患者，这些患者具有大血管闭塞、美国国立卫生研究院卒中量表（NIHSS）评分≥4 分、以及在发病后 24 小时内进行了多模态血管成像、缺血核心成像和组织危险成像。初始速度（SIP）的计算方法为首次成像时的缺血核心体积除以从卒中发病到成像的时间。
在 88 例患者中，SIP 中位数为 2.2cc/h（四分位距，0-8.7），在发病后最初 6 小时内变化范围最广。更快的 SIP 与较低的侧支评分（比值比 [OR]，3.30[95%可信区间，1.25-10.49]）和通过紧急医疗服务到达（OR，3.34[95%可信区间，1.06-10.49]）呈正相关，与既往缺血性卒中（OR，0.12[95%可信区间，0.03-0.50]）和冠状动脉疾病（OR，0.32[95%可信区间，0.10-1.00]）呈负相关。在 67 例接受血管内血栓切除术的患者中，SIP 较慢与出院时残疾程度降低相关（OR，3.26[95%可信区间，1.02-10.45]）、血栓切除术的实质性再灌注增加（OR，8.30[95%可信区间，0.97-70.87]）和影像学出血性转化减少（OR，0.34[95%可信区间，0.12-0.94]）。
较慢的 SIP 与侧支丰富、既往缺血性卒中以及冠状动脉疾病相关，支持侧支稳定性和缺血预适应在促进组织对缺血的耐受性方面的作用。在接受血管内血栓切除术的患者中，梗死进展速度是临床结局的主要决定因素。
