Grosch Anne Sophie, Kufner Anna, Boutitie Florent, Cheng Bastian, Ebinger Martin, Endres Matthias, Fiebach Jochen B, Fiehler Jens, Königsberg Alina, Lemmens Robin, Muir Keith W, Nighoghossian Norbert, Pedraza Salvador, Siemonsen Claus Z, Thijs Vincent, Wouters Anke, Gerloff Christian, Thomalla Götz, Galinovic Ivana
Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Front Neurol. 2021 Feb 4;11:623881. doi: 10.3389/fneur.2020.623881. eCollection 2020.
Fluid-attenuated inversion recovery (FLAIR) hyperintense vessels (FHVs) on MRI are a radiological marker of vessel occlusion and indirect sign of collateral circulation. However, the clinical relevance is uncertain. We explored whether the extent of FHVs is associated with outcome and how FHVs modify treatment effect of thrombolysis in a subgroup of patients with confirmed unilateral vessel occlusion from the randomized controlled WAKE-UP trial. One hundred sixty-five patients were analyzed. Two blinded raters independently assessed the presence and extent of FHVs (defined as the number of slices with visible FHV multiplied by FLAIR slice thickness). Patients were then separated into two groups to distinguish between few and extensive FHVs (dichotomization at the median <30 or ≥30). Here, 85% of all patients ( = 140) and 95% of middle cerebral artery (MCA) occlusion patients ( = 127) showed FHVs at baseline. Between MCA occlusion patients with few and extensive FHVs, no differences were identified in relative lesion growth ( = 0.971) and short-term [follow-up National Institutes of Health Stroke Scale (NIHSS) score; = 0.342] or long-term functional recovery [modified Rankin Scale (mRS) <2 at 90 days poststroke; = 0.607]. In linear regression analysis, baseline extent of FHV (defined as a continuous variable) was highly associated with volume of hypoperfused tissue (β = 2.161; 95% CI 0.96-3.36; = 0.001). In multivariable regression analysis adjusted for treatment group, stroke severity, lesion volume, occlusion site, and recanalization, FHV did not modify functional recovery. However, in patients with few FHVs, the odds for good functional outcome (mRS) were increased in recombinant tissue plasminogen activator (rtPA) patients compared to those who received placebo [odds ratio (OR) = 5.3; 95% CI 1.2-24.0], whereas no apparent benefit was observed in patients with extensive FHVs (OR = 1.1; 95% CI 0.3-3.8), -value for interaction was 0.11. While the extent of FHVs on baseline did not alter the evolution of stroke in terms of lesion progression or functional recovery, it may modify treatment effect and should therefore be considered relevant additional information in those patients who are eligible for intravenous thrombolysis. Main trial (WAKE-UP): ClinicalTrials.gov, NCT01525290; and EudraCT, 2011-005906-32. Registered February 2, 2012.
磁共振成像（MRI）上的液体衰减反转恢复（FLAIR）高信号血管（FHVs）是血管闭塞的影像学标志和侧支循环的间接征象。然而，其临床相关性尚不确定。我们在随机对照的WAKE-UP试验中，对一组确诊为单侧血管闭塞的患者进行了研究，探讨FHVs的范围是否与预后相关，以及FHVs如何影响溶栓治疗效果。分析了165例患者。两名盲法评估者独立评估FHVs的存在和范围（定义为可见FHVs的层数乘以FLAIR层厚）。然后将患者分为两组，以区分FHVs少和多的情况（以中位数<30或≥30进行二分法）。在此，所有患者的85%（n = 140）和大脑中动脉（MCA）闭塞患者的95%（n = 127）在基线时显示有FHVs。在FHVs少和多的MCA闭塞患者之间，相对病变生长（P = 0.971）、短期[随访美国国立卫生研究院卒中量表（NIHSS）评分；P = 0.342]或长期功能恢复[卒中后90天改良Rankin量表（mRS）<2；P = 0.607]方面均未发现差异。在线性回归分析中，FHV的基线范围（定义为连续变量）与灌注不足组织的体积高度相关（β = 2.161；95%可信区间0.96 - 3.36；P = 0.001）。在对治疗组、卒中严重程度、病变体积、闭塞部位和再通进行调整的多变量回归分析中，FHV并未改变功能恢复情况。然而，在FHVs少的患者中，与接受安慰剂的患者相比，重组组织型纤溶酶原激活剂（rtPA）治疗的患者获得良好功能预后（mRS）的几率增加[比值比（OR） = 5.3；95%可信区间1.2 - 24.0]，而在FHVs多的患者中未观察到明显益处（OR = 1.1；95%可信区间0.3 - 3.8），交互作用的P值为0.11。虽然基线时FHVs的范围在病变进展或功能恢复方面并未改变卒中的演变，但它可能会影响治疗效果，因此在符合静脉溶栓条件的患者中应将其视为相关补充信息。主要试验（WAKE-UP）：ClinicalTrials.gov，NCT01525290；以及欧盟临床试验注册数据库，2011-005906-�2。于2012年2月2日注册。
