Acute Stroke Unit (J.-M.O., J.-F.A., A.V., L.C., N.R.), Centre Hospitalier Universitaire de Toulouse, France.
Clinical Investigation Center 1436 (J.-M.O., J.-F.A., C.T., V.R., A.D., A.S., A.V., L.C., N.R.), Centre Hospitalier Universitaire de Toulouse, France.
Stroke. 2021 Jan;52(1):232-240. doi: 10.1161/STROKEAHA.120.031929. Epub 2020 Dec 22.
Mechanical thrombectomy (MT) is the recommended treatment for acute ischemic stroke caused by anterior circulation large vessel occlusion. However, despite a high rate of reperfusion, the clinical response to successful MT remains highly variable in the early time window where optimal imaging selection criteria have not been established. We hypothesize that the baseline perfusion imaging profile may help forecast the clinical response to MT in this setting.
We conducted a prospective multicenter cohort study of patients with large vessel occlusion-related acute ischemic stroke treated by MT within 6 hours. Treatment decisions and the modified Rankin Scale evaluation at 3 months were performed blinded to the results of baseline perfusion imaging. Study groups were defined a posteriori based on predefined imaging profiles: target mismatch (TMM; core volume <70 mL/mismatch ratio >1.2 and mismatch volume >10 mL) versus no TMM or mismatch (MM; mismatch ratio >1.2 and volume >10 mL) versus no MM. Functional recovery (modified Rankin Scale, 0-2) at 3 months was compared based on imaging profile at baseline and whether reperfusion (modified Thrombolysis in Cerebral Infarction 2bc3) was achieved.
Two hundred eighteen patients (mean age, 71±15 years; median National Institutes of Health Stroke Scale score, 17 [interquartile range, 12-21]) were enrolled. Perfusion imaging profiles were 71% TMM and 82% MM. The rate of functional recovery was 54% overall. Both TMM and MM profiles were independently associated with a higher rate on functional recovery at 3 months Adjusted odds ratios were 3.3 (95% CI, 1.4-7.9) for TMM and 5.9 (95% CI, 1.8-19.6) for MM. Reperfusion (modified Thrombolysis in Cerebral Infarction 2bc3) was achieved in 86% and was more frequent in TMM and MM patients. Reperfusion was associated with a higher rate of functional recovery in MM and TMM patients but not among those with no MM.
In this cohort study, about 80% of the patients with a large vessel occlusion-related acute ischemic stroke had evidence of penumbra, regardless of infarction volume. Perfusion imaging profiles predict the clinical response to MT.
机械取栓（MT）是治疗前循环大血管闭塞引起的急性缺血性脑卒中的推荐疗法。然而，尽管再灌注率很高，但在尚未确定最佳影像学选择标准的早期时间窗内，对 MT 成功治疗的临床反应仍然高度可变。我们假设基线灌注成像特征可能有助于预测这种情况下 MT 的临床反应。
我们对在 6 小时内接受 MT 治疗的大血管闭塞相关急性缺血性脑卒中患者进行了一项前瞻性多中心队列研究。治疗决策和 3 个月时的改良 Rankin 量表评估是在对基线灌注成像结果不知情的情况下进行的。根据预先定义的成像特征，将研究组分为后验：靶标不匹配（TMM；核心体积＜70mL/不匹配比＞1.2 且不匹配体积＞10mL）与无 TMM 或不匹配（MM；不匹配比＞1.2 且体积＞10mL）与无 MM。根据基线成像特征和是否达到再灌注（改良脑梗死溶栓 2bc3），比较 3 个月时的功能恢复（改良 Rankin 量表，0-2）。
共纳入 218 例患者（平均年龄 71±15 岁；中位国立卫生研究院卒中量表评分 17[四分位距 12-21]）。灌注成像特征为 71%TMM 和 82%MM。总的功能恢复率为 54%。TMM 和 MM 两种成像特征均与 3 个月时的功能恢复率较高独立相关。调整后的优势比分别为 TMM 3.3（95%CI，1.4-7.9）和 MM 5.9（95%CI，1.8-19.6）。86%的患者实现了再灌注（改良脑梗死溶栓 2bc3），TMM 和 MM 患者的再灌注更频繁。再灌注与 MM 和 TMM 患者的功能恢复率较高相关，但在无 MM 的患者中无此相关性。
在这项队列研究中，约 80%的大血管闭塞相关急性缺血性脑卒中患者存在半暗带证据，无论梗死体积如何。灌注成像特征可预测 MT 的临床反应。
