Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Neurol. 2021 Jun;268(6):2213-2222. doi: 10.1007/s00415-021-10410-2. Epub 2021 Jan 24.
The presence of metabolically viable brain tissue that may be salvageable with rapid cerebral blood flow restoration is the fundament rationale for reperfusion therapy in patients with large vessel occlusion stroke. The effect of endovascular treatment (EVT) on functional outcome largely depends on the degree of recanalization. However, the relationship of recanalization degree and penumbra salvage has not yet been investigated. We hypothesized that penumbra salvage volume mediates the effect of thrombectomy on functional outcome.
99 acute anterior circulation stroke patients who received multimodal CT and underwent thrombectomy with resulting partial to complete reperfusion (modified thrombolysis in cerebral infarction scale (mTICI) ≥ 2a) were retrospectively analyzed. Penumbra volume was quantified on CT perfusion and penumbra salvage volume (PSV) was calculated as difference of penumbra and net infarct growth from admission to follow-up imaging.
In patients with complete reperfusion (mTICI ≥ 2c), the median PSV was significantly higher than the median PSV in patients with partial or incomplete (mTICI 2a-2b) reperfusion (median 224 mL, IQR: 168-303 versus 158 mL, IQR: 129-225; p < 0.01). A higher degree of recanalization was associated with increased PSV (+ 63 mL per grade, 95% CI: 17-110; p < 0.01). Higher PSV was also associated with improved functional outcome (OR/mRS shift: 0.89; 95% CI: 0.85-0.95, p < 0.0001).
PSV may be an important mediator between functional outcome and recanalization degree in EVT patients and could serve as a more accurate instrument to compare treatment effects than infarct volumes.
存在可能通过快速脑血流恢复而挽救的代谢活跃的脑组织是大血管闭塞性卒中患者再灌注治疗的基本原理。血管内治疗 (EVT) 对功能结局的影响在很大程度上取决于再通程度。然而，再通程度与半暗带挽救之间的关系尚未得到研究。我们假设半暗带挽救体积介导取栓对功能结局的影响。
回顾性分析了 99 例接受多模态 CT 检查并接受取栓治疗的急性前循环卒中患者，结果为部分至完全再通（改良脑梗死溶栓分级（mTICI）≥2a）。CT 灌注量化了半暗带体积，半暗带挽救体积（PSV）计算为从入院到随访成像的半暗带和净梗死增长的差异。
在完全再通（mTICI≥2c）的患者中，PSV 的中位数明显高于部分或不完全再通（mTICI 2a-2b）患者（中位数 224ml，IQR：168-303 与 158ml，IQR：129-225；p<0.01）。再通程度越高，PSV 越高（每级增加 63ml，95%CI：17-110；p<0.01）。PSV 越高，功能结局也越好（OR/mRS 变化：0.89；95%CI：0.85-0.95，p<0.0001）。
PSV 可能是 EVT 患者功能结局和再通程度之间的重要中介，并且可以作为比梗死体积更准确的比较治疗效果的工具。
