Neurology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
Radiological Sciences, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.
J Neurointerv Surg. 2021 Nov;13(11):990-994. doi: 10.1136/neurintsurg-2020-016834. Epub 2020 Dec 18.
Targeted eloquence-based tissue reperfusion within the primary motor cortex may have a differential effect on disability as compared with traditional volume-based (thrombolysis in cerebral infarction, TICI) reperfusion after endovascular thrombectomy (EVT) in the setting of acute ischemic stroke (AIS).
We explored the impact of eloquent reperfusion (ER) within primary motor cortex (PMC) on clinical outcome (modified Rankin Scale, mRS) in AIS patients undergoing EVT. ER-PMC was defined as presence of flow on final digital subtraction angiography (DSA) within four main cortical branches, supplying the PMC (middle cerebral artery (MCA) - precentral, central, postcentral; anterior cerebral artery (ACA) - medial frontal branch arising from callosomarginal or pericallosal arteries) and graded as absent (0), partial (1), and complete (2). Prospectively collected data from two centers were analyzed. Multivariate analysis was conducted to assess the impact of ER-PMC on 90-day disability (mRS) among patients with anterior circulation occlusion who achieved partial reperfusion (TICI 2a and 2b).
Among the 125 patients who met the study criteria, ER-PMC distribution was: absent (0) in 19/125 (15.2%); partial (1) in 52/125 (41.6%), and complete (2) in 54/125 (43.2%). TICI 2b was achieved in 102/125 (81.6%) and ER-PMC was substantially higher in those patients (P<0.001). In multivariate analysis, in addition to age and symptomatic intracranial hemorrhage, ER-PMC had a profound independent impact on 90-day disability (OR 6.10, P=0.001 for ER-PMC 1 vs 0 and OR 9.87, P<0.001 for ER-PMC 2 vs 0), while the extent of total partial reperfusion (TICI 2b vs 2a) was not related to 90-day mRS.
Eloquent PMC-tissue reperfusion is a key determinant of functional outcome, with a greater impact than volume-based (TICI) degree of partial reperfusion alone. PMC-targeted revascularization among patients with partial reperfusion may further diminish post-stroke disability after EVT.
与血管内血栓切除术（EVT）后传统的基于容积的（脑梗死溶栓，TICI）再灌注相比，靶向大脑运动皮质内的特定区域进行再灌注可能会对急性缺血性脑卒中（AIS）患者的残疾状况产生不同的影响。
我们研究了大脑运动皮质（PMC）内的特定区域再灌注（ER）对接受 EVT 的 AIS 患者临床结局（改良 Rankin 量表，mRS）的影响。ER-PMC 定义为在最终数字减影血管造影（DSA）上，四条主要皮质分支（大脑中动脉（MCA）-中央前回、中央后回；大脑前动脉（ACA）-来自胼周或胼胝体动脉的额内侧支）内存在血流，其分级为无（0）、部分（1）和完全（2）。对来自两个中心的前瞻性收集的数据进行了分析。进行多变量分析以评估 ER-PMC 在达到部分再灌注（TICI 2a 和 2b）的前循环闭塞患者 90 天残疾（mRS）中的作用。
在符合研究标准的 125 例患者中，ER-PMC 的分布情况为：无（0）为 19/125（15.2%）；部分（1）为 52/125（41.6%），完全（2）为 54/125（43.2%）。125 例患者中有 102 例（81.6%）达到 TICI 2b，这些患者的 ER-PMC 明显更高（P<0.001）。在多变量分析中，除了年龄和症状性颅内出血外，ER-PMC 对 90 天残疾有显著的独立影响（与 ER-PMC 0 相比，OR 6.10，P=0.001；与 ER-PMC 0 相比，OR 9.87，P<0.001），而总部分再灌注的程度（TICI 2b 与 2a）与 90 天 mRS 无关。
大脑运动皮质内特定区域的再灌注是功能结局的关键决定因素，其影响大于基于容积的（TICI）部分再灌注程度的影响。在部分再灌注的患者中进行 PMC 靶向再血管化治疗可能会进一步降低 EVT 后卒中后的残疾程度。
