Gwak Dong-Seok, Kwon Jung-A, Shim Dong-Hyun, Kim Yong-Won, Hwang Yang-Ha
Department of Neurology, Kyungpook National University Hospital, Daegu, Korea.
Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Korea.
J Stroke. 2021 Jan;23(1):61-68. doi: 10.5853/jos.2020.01466. Epub 2021 Jan 31.
Patients with acute large vessel occlusion (LVO) presenting with mild stroke symptoms are at risk of early neurological deterioration (END). This study aimed to identify the optimal imaging variables for predicting END in this population.
We retrospectively analyzed 94 patients from the prospectively maintained institutional stroke registry admitted between January 2011 and May 2019, presenting within 24 hours after onset, with a baseline National Institutes of Health Stroke Scale score ≤5 and anterior circulation LVO. Patients who underwent endovascular therapy before END were excluded. Volumes of Tmax delay (at >2, >4, >6, >8, and >10 seconds), mismatch (Tmax >4 seconds - diffusion-weighted imaging [DWI] and Tmax >6 seconds - DWI), and mild hypoperfusion lesions (Tmax 2-6 and 4-6 seconds) were measured. The association of each variable with END was examined using receiver operating characteristic curves. The variables with best predictive performance were dichotomized at the cutoff point maximizing Youden's index and subsequently analyzed using multivariable logistic regression.
END occurred in 39.4% of the participants. The optimal variables were identified as Tmax >6 seconds, Tmax >6 seconds - DWI, and Tmax 4-6 seconds with cut-off points of 53.73, 32.77, and 55.20 mL, respectively. These variables were independently associated with END (adjusted odds ratio [aOR], 12.78 [95% confidence interval (CI), 3.36 to 48.65]; aOR, 5.73 [95% CI, 2.04 to 16.08]; and aOR, 9.13 [95% CI, 2.76 to 30.17], respectively).
Tmax >6 seconds, Tmax >6 seconds - DWI, and Tmax 4-6 seconds could identify patients at high risk of END following minor stroke due to LVO.
表现为轻度卒中症状的急性大血管闭塞（LVO）患者存在早期神经功能恶化（END）风险。本研究旨在确定该人群中预测END的最佳影像变量。
我们回顾性分析了2011年1月至2019年5月期间前瞻性维护的机构卒中登记处的94例患者，这些患者发病后24小时内就诊，基线美国国立卫生研究院卒中量表评分≤5且为前循环LVO。排除在END前接受血管内治疗的患者。测量Tmax延迟（>2、>4、>6、>8和>10秒时）、不匹配（Tmax>4秒 - 弥散加权成像 [DWI]和Tmax>6秒 - DWI）以及轻度灌注不足病变（Tmax 2 - 6和4 - 6秒）的体积。使用受试者工作特征曲线检查每个变量与END的关联。在使约登指数最大化的临界点将具有最佳预测性能的变量进行二分法划分，随后使用多变量逻辑回归进行分析。
39.4%的参与者发生了END。最佳变量确定为Tmax>6秒、Tmax>6秒 - DWI和Tmax 4 - 6秒，截断点分别为53.73、32.77和55.20 mL。这些变量与END独立相关（调整后的优势比 [aOR]分别为12.78 [95%置信区间 (CI)，3.36至48.65]；aOR为5.73 [95% CI，2.04至16.08]；aOR为9.13 [95% CI，2.76至30.17]）。
Tmax>6秒、Tmax>6秒 - DWI和Tmax 4 - 6秒可识别LVO导致的轻度卒中后END高风险患者。
