Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France.
Department of Neurology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France.
Eur Radiol. 2021 Oct;31(10):7406-7416. doi: 10.1007/s00330-021-07866-1. Epub 2021 Apr 14.
To establish whether imaging assessments of irreversibly injured ischemic core and potentially salvageable penumbral volumes and collateral circulation were associated with functional outcome in nonagenarians (90 years or older) undergoing endovascular thrombectomy (EVT).
Data from a prospectively maintained institutional registry of consecutive stroke patients treated with EVT from January 2012 to December 2018 were retrospectively analyzed. Functional outcome was evaluated with the modified Rankin scale (mRS) at 3 months. mRS score of 0-3 was defined as a good clinical outcome. Ischemic core and penumbral volumes were calculated using the RAPID software. Quantification of collateral circulation was performed using a fluid-attenuated inversion recovery vascular hyperintensity (FVH)-Alberta Stroke Program Early CT Score (ASPECTS) rating system.
Among 85 patients (age, 92.4 ± 2.6 years; men, 30.6%) treated with EVT, good outcome (mRS 0-3) was achieved in 29 (34.1%) patients and 31 (36.5%) patients died at 90 days. The median estimated ischemic core volume was 15 mL (IQR, 7-27 mL). The median mismatch volume was 83 mL (IQR, 43-120 mL). The median FVH score was 4 (IQR, 3-4). FVH score was independently associated with good functional outcome (adjusted OR = 1.96 [95% CI, 1.16-3.32]; p = 0.01 per 1-point increase) and mortality (adjusted OR = 0.54 [95% CI, 0.34-0.85]; p = 0.007 per 1-point increase). Ischemic core and mismatch volumes were associated with neither good outcome nor mortality.
In nonagenarians with anterior circulation large-vessel ischemic stroke, good collaterals as measured by the FVH-ASPECTS rating system are independently associated with improved outcomes and may help select patients for reperfusion therapy in this frail population.
• Endovascular thrombectomy can allow at least 1 in 3 patients older than 90 years of age to achieve good functional outcome (modified Rankin scale of 0-3) at 3 months. • Functional outcome at 3 months is associated with pre-stroke status (number and severity of patients' comorbidities). • A higher FVH score (as reflected by higher FLAIR vascular hyperintensity [FVH]-Alberta Stroke Program Early CT Score [ASPECTS] values) is independently associated with better 3-month functional outcome and mortality in nonagenarians with anterior circulation ischemic stroke.
探讨评估不可逆性缺血核心和潜在可挽救的缺血半暗带体积以及侧支循环的影像学指标与 90 岁以上（90 岁及以上）接受血管内血栓切除术（EVT）治疗的非老年患者的功能结局是否相关。
回顾性分析 2012 年 1 月至 2018 年 12 月连续接受 EVT 治疗的前瞻性维护机构登记的中风患者的数据。采用改良 Rankin 量表（mRS）评估 3 个月时的功能结局。mRS 评分为 0-3 定义为临床结局良好。使用 RAPID 软件计算缺血核心和缺血半暗带体积。采用液体衰减反转恢复血管高信号（FVH）-阿尔伯塔卒中计划早期 CT 评分（ASPECTS）评分系统对侧支循环进行定量评估。
在 85 名接受 EVT 治疗的患者（年龄 92.4±2.6 岁；男性 30.6%）中，29 名（34.1%）患者获得了良好的临床结局（mRS 0-3），31 名（36.5%）患者在 90 天内死亡。估计的缺血核心体积中位数为 15ml（IQR，7-27ml）。缺血半暗带体积中位数为 83ml（IQR，43-120ml）。FVH 评分中位数为 4 分（IQR，3-4 分）。FVH 评分与良好的功能结局（调整后的比值比=1.96[95%可信区间，1.16-3.32]；每增加 1 分，p=0.01）和死亡率（调整后的比值比=0.54[95%可信区间，0.34-0.85]；每增加 1 分，p=0.007）独立相关。缺血核心和缺血半暗带体积与良好结局或死亡率均无相关性。
在前循环大血管闭塞性中风的 90 岁以上患者中，以 FVH-ASPECTS 评分系统测量的良好侧支循环与改善结局独立相关，可能有助于在这一脆弱人群中选择再灌注治疗的患者。
血管内血栓切除术可使至少 1/3 的 90 岁以上患者在 3 个月时达到良好的功能结局（改良 Rankin 量表 0-3 分）。
3 个月时的功能结局与发病前状态（患者合并症的数量和严重程度）相关。
在前循环缺血性中风患者中，较高的 FVH 评分（反映为较高的 FLAIR 血管高信号[FVH]-ASPECTS 值）与 3 个月时更好的功能结局和死亡率独立相关。
