From the Department of Neurology (L.L., J.Y.), Ningbo First Hospital, China; School of Medicine and Public Health (L.L., C.C., H.T., N.J.S., C.R.L., M.W.P.), University of Newcastle; Melbourne Brain Centre at Royal Melbourne Hospital (A.B., M.W.P.), University of Melbourne; and The Sydney Partnership for Health, Education, Research and Enterprise (C.R.L.), Australia.
Neurology. 2021 Jan 12;96(2):e161-e170. doi: 10.1212/WNL.0000000000011258. Epub 2020 Dec 1.
To test the hypothesis that patients with acute ischemic stroke with poorer collaterals would have faster ischemic core growth, we included 2 cohorts in the study: cohort 1 of 342 patients for derivation and cohort 2 of 414 patients for validation.
Patients with acute ischemic stroke with large vessel occlusion were included. Core growth rate was calculated by the following equation: core growth rate = acute core volume on CT perfusion (CTP)/time from stroke onset to CTP. Collateral status was assessed by the ratio of severe hypoperfusion volume within the hypoperfusion region of CTP. The CTP collateral index was categorized in tertiles; for each tertile, core growth rate was summarized as median and interquartile range. Simple linear regressions were then performed to measure the predictive power of CTP collateral index in core growth rate.
For patients allocated to good collateral on CTP (tertile 1 of collateral index), moderate collateral (tertile 2), and poor collateral (tertile 3), the median core growth rate was 2.93 mL/h (1.10-7.94), 8.65 mL/h (4.53-18.13), and 25.41 mL/h (12.83-45.07), respectively. Increments in the collateral index by 1% resulted in an increase of core growth by 0.57 mL/h (coefficient 0.57, 95% confidence interval [0.46, 0.68], < 0.001). The relationship of core growth and CTP collateral index was validated in cohort 2. An increment in collateral index by 1% resulted in an increase of core growth by 0.59 mL/h (coefficient 0.59 [0.48-0.71], < 0.001) in cohort 2.
Collateral status is a major determinant of ischemic core growth.
为验证如下假说，我们纳入了两个队列的研究患者：队列 1 为 342 例患者，用于推导；队列 2 为 414 例患者，用于验证。假说内容为：伴有较差侧支循环的急性缺血性脑卒中患者，其缺血核心会有更快的增长。方法：纳入存在大血管闭塞的急性缺血性脑卒中患者。核心增长速率通过以下公式计算：核心增长速率=CTP 时的急性核心体积/从脑卒中发病到 CTP 的时间。侧支循环状态通过 CTP 时低灌注区域内严重低灌注体积的比值进行评估。CTP 侧支指数按三分位分组；对于每个三分位，核心增长速率以中位数和四分位间距进行总结。然后进行简单线性回归，以测量 CTP 侧支指数对核心增长速率的预测能力。结果：对于 CTP 侧支循环良好（侧支指数三分位 1）、中度（三分位 2）和较差（三分位 3）的患者，中位核心增长速率分别为 2.93mL/h（1.10-7.94）、8.65mL/h（4.53-18.13）和 25.41mL/h（12.83-45.07）。侧支指数增加 1%，核心增长增加 0.57mL/h（系数 0.57，95%置信区间[0.46，0.68]， < 0.001）。在队列 2 中验证了核心增长与 CTP 侧支指数的关系。侧支指数增加 1%，核心增长增加 0.59mL/h（系数 0.59[0.48-0.71]， < 0.001）。结论：侧支循环状态是缺血核心增长的主要决定因素。
