Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany; Department of Neurology, University of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany.
Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
J Stroke Cerebrovasc Dis. 2020 Dec;29(12):105358. doi: 10.1016/j.jstrokecerebrovasdis.2020.105358. Epub 2020 Oct 6.
Space-occupying cerebral edema is the main cause of mortality and poor functional outcome in patients with large cerebral artery occlusion (LVO). We aimed to determine whether recanalization of LVO would augment cerebral edema volume and the impact on functional outcome and quality of life (QoL).
Prospectively, 43 patients with large middle cerebral artery territory infarction or NIHSS ≥ 12 on admission were enrolled. The degree of recanalization (partial and complete versus no recanalization) was assessed by computed tomography (CT)-angiography or Duplex ultrasound more than 24 h after symptom onset. Cerebral edema volume was measured on follow up CTs by computer-based planimetry. Mortality, functional outcome (by modified Ranking Scale (mRS) and Barthel Index (BI)) were assessed at discharge and 12 months, and QoL (by SF-36 and EQ-5D-3L) at 12 months.
Mean cerebral edema volume was 333±141 ml without recanalization (n=13, group 1) and 276±140 ml with partial or complete recanalization (n=30, group 2, p= 0.23). There were no significant differences in mortality at discharge (38% versus 23%), at 12 months (58% versus 48%), in functional outcome at discharge (mRS 0-3: 0% both; mRS 4-5: 62% versus 77%) and at 12 months (mRS 0-3: 0% versus 11%; mRS 4-5: 42% versus 41%). The BI improved significantly from discharge to 12 months only in group 2 (p=0.001). Mean physical component score in SF-36 was 25.6±6.4, psychological component score was 41.9±14.1. In the EQ-5D-3L, most patients reported problems with activities of daily living, reduced mobility, and selfcare.
Recanalization of a large cerebral artery occlusion in the anterior circulation territories is not associated with amplification of post-ischemic cerebral edema but may be correlated with better long-term functional outcome. QoL was low and mainly dependent on physical disability. The association between recanalization, collateral status and development of cerebral edema after LVO and the effect on functional outcome and quality of life should be explored in a larger patient population.
占位性脑水肿是大脑中动脉闭塞（LVO）患者死亡和功能预后不良的主要原因。本研究旨在确定 LVO 的再通是否会增加脑水肿体积，以及对功能预后和生活质量（QoL）的影响。
前瞻性纳入 43 例大脑中动脉区域大面积梗死或入院时 NIHSS≥12 的患者。发病 24 小时后，通过计算机断层血管造影（CTA）或双功能超声评估再通程度（部分和完全再通与无再通）。通过计算机平面测量随访 CT 上的脑水肿体积。出院时和 12 个月时评估死亡率、功能预后（改良 Rankin 量表（mRS）和巴氏指数（BI）），12 个月时评估生活质量（SF-36 和 EQ-5D-3L）。
无再通（n=13，1 组）和部分或完全再通（n=30，2 组）的脑水肿体积分别为 333±141ml 和 276±140ml（p=0.23）。出院时死亡率（38%与 23%）、12 个月时死亡率（58%与 48%）、出院时功能预后（mRS 0-3：均为 0%；mRS 4-5：62%与 77%）和 12 个月时功能预后（mRS 0-3：0%与 11%；mRS 4-5：42%与 41%）无显著差异。仅在 2 组中 BI 从出院时到 12 个月时显著改善（p=0.001）。SF-36 的生理成分评分平均为 25.6±6.4，心理成分评分为 41.9±14.1。在 EQ-5D-3L 中，大多数患者报告日常生活活动、移动能力和自理能力存在问题。
大脑前循环区域大血管闭塞的再通与缺血后脑水肿的放大无关，但可能与长期功能预后较好有关。生活质量较低，主要取决于身体残疾。应在更大的患者人群中探讨 LVO 后再通、侧支状态与脑水肿的发展及其对功能预后和生活质量的影响之间的关系。
