Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Neurology, Barrow Neurological Institute, Phoenix, Arizona, USA.
J Neurointerv Surg. 2022 Jan;14(1). doi: 10.1136/neurintsurg-2021-017394. Epub 2021 Mar 25.
Heterogeneity in the infarct growth rate among anterior circulation large vessel occlusion (LVO) strokes has triage and treatment implications. Such data are lacking for basilar artery occlusion (BAO) strokes. We aim to describe the variability in brainstem infarct volume at presentation and compute the distribution of the infarct growth rate (IGR) and rate of loss of neurons during BAO strokes.
A retrospective review of consecutive patients with BAO stroke with pretreatment MRI was performed. Ischemic core volume was manually calculated (product of slice thickness and sum of area of region of interests) for the brainstem lesion. The distribution of various brainstem infarct volume groups was analyzed and the IGR (including rate of loss of neurons) was computed.
Fifty-nine patients were included. Mean age was 64±13 and 34% were men. Mean National Institutes of Health Stroke Scale score was 20±11 and time to MRI was 9±5 hours. Mean brainstem ischemic core volume was 4.5±4.6 mL. According to predefined thresholds, 13% and 6% of patients with BAO stroke in the 0-6 hour time window were fast (5-10 mL) and ultra-fast progressors (>10 mL), respectively, and 14% of patients in the 6-24 hour time window were slow progressors (<1 mL). Median and mean rate of loss of neurons was 146 300 neurons/min and 261 300 (±400 000) neurons/min, respectively, and ranged from <19 400 to >2.12 million.
Approximately 14% of BAO strokes are slow progressors and 19% are fast/ultra-fast progressors, with the rate of loss of neurons ranging from <19 000 to >2.1 million/min. Large heterogeneity exists in brainstem infarct volume at presentation and IGR among patients with BAO stroke.
前循环大血管闭塞（LVO）卒中的梗死增长率存在异质性，这对患者的分诊和治疗具有重要意义。然而，基底动脉闭塞（BAO）卒中的相关数据却有所欠缺。本研究旨在描述 BAO 卒中患者发病时脑干梗死体积的变化，并计算梗死增长率（IGR）和神经元丢失率的分布。
对连续接受 BAO 卒中治疗且有预处理 MRI 的患者进行回顾性研究。通过手动计算（层厚与感兴趣区域面积的乘积）脑干病变的缺血核心体积。分析各种脑干梗死体积组的分布情况，并计算 IGR（包括神经元丢失率）。
共纳入 59 例患者，平均年龄为 64±13 岁，34%为男性，平均 NIHSS 评分为 20±11，MRI 时间为 9±5 小时。平均脑干缺血核心体积为 4.5±4.6 mL。根据预设的阈值，BAO 卒中发病后 0-6 小时的患者中，13%和 6%为快速（5-10 mL）和超快进展者（>10 mL），6-24 小时的患者中，14%为进展缓慢者（<1 mL）。神经元丢失率的中位数和平均值分别为 146 300 个/分钟和 261 300（±400 000）个/分钟，范围为<19 400-2.12 百万个/分钟。
大约 14%的 BAO 卒中患者为进展缓慢者，19%为快速/超快进展者，神经元丢失率范围为<19 000-2.12 百万个/分钟。BAO 卒中患者的脑干梗死体积和 IGR 存在很大的异质性。
