Department of Radiology, Universitatsspital Basel, Basel, Switzerland.
Department of Diagnostic Imaging, Foothills Medical Centre, Calgary, Alberta, Canada.
J Neurointerv Surg. 2022 Sep;14(9):886-891. doi: 10.1136/neurintsurg-2021-017994. Epub 2021 Sep 7.
Determining infarct progression rate in acute ischemic stroke (AIS) is important for patient triage, treatment decision-making, and outcome prognostication.
To estimate infarct progression rate in patients with AIS with large vessel occlusion (LVO) and determine its predictors and impact on clinical outcome.
Data are from the ESCAPE-NA1 Trial. Patients with AIS with time from last known well to randomization <6 hours and near-complete reperfusion following endovascular treatment were included. Infarct growth rate (mL/h) was estimated by dividing 24 hour infarct volume (measured by non-contrast CT or diffusion-weighted magnetic resonance imaging) by time from last known well to reperfusion. Multivariable linear regression was used to assess the association of patient baseline variables with log-transformed infarct progression rate. The association of infarct progression rate and good outcome (modified Rankin Scale score 0-2) was determined using multivariable logistic regression.
Four hundred and nine patients were included in the study. Median infarct progression rate was 4.74 mL/h (IQR 1.25-14.84). Collateral status (β: -0.81 (95% CI -1.20 to -0.41)), Alberta Stroke Program Early CT Score (ASPECTS, β: -0.34 (95% CI -0.46 to -0.23)), blood glucose(β: 0.09 (95% CI 0.02 to 0.16)), and National Institutes of Health Stroke Scale (NIHS score (β: 0.07 (95% CI 0.04 to 0.10)) were associated with log-transformed infarct progression rate. Clinical and imaging baseline variables explained 23% of the variance in infarct progression rate. Infarct progression rate was significantly associated with good outcome (aOR per 1 mL/h increase: 0.96 (95% CI 0.95 to 0.98)).
In this sample of patients presenting within the early time window with LVO and near-complete recanalization, infarct progression rate was significantly associated with good outcome. A significant association between ASPECTS, collateral status, blood glucose, and NIHSS score was observed, but baseline imaging and clinical characteristics explained only a small proportion of the interindividual variance. More research on measurable factors affecting infarct growth is needed.
确定急性缺血性脑卒中（AIS）患者的梗死进展率对于患者分诊、治疗决策和预后预测非常重要。
评估血管内治疗后接近完全再通的大血管闭塞（LVO）AIS 患者的梗死进展率，并确定其预测因素及其对临床结局的影响。
数据来自 ESCAPE-NA1 试验。纳入发病至随机时间<6 小时且血管内治疗后接近完全再通的 AIS 患者。通过将 24 小时梗死体积（通过非对比 CT 或弥散加权磁共振成像测量）除以从最后一次知晓到再灌注的时间，来估计梗死生长率（mL/h）。采用多变量线性回归评估患者基线变量与对数转化的梗死进展率之间的关联。采用多变量逻辑回归评估梗死进展率与良好结局（改良 Rankin 量表评分 0-2）之间的关系。
本研究共纳入 409 例患者。中位梗死进展率为 4.74 mL/h（IQR 1.25-14.84）。侧支状态（β：-0.81（95%CI-1.20 至-0.41））、 Alberta 卒中项目早期 CT 评分（ASPECTS，β：-0.34（95%CI-0.46 至-0.23））、血糖（β：0.09（95%CI 0.02 至 0.16））和国立卫生研究院卒中量表（NIHSS 评分，β：0.07（95%CI 0.04 至 0.10））与对数转化的梗死进展率相关。临床和影像学基线变量解释了梗死进展率变异的 23%。梗死进展率与良好结局显著相关（每增加 1 mL/h 的优势比：0.96（95%CI 0.95 至 0.98））。
在本研究中，在早期时间窗内出现 LVO 且接近完全再通的患者中，梗死进展率与良好结局显著相关。观察到 ASPECTS、侧支状态、血糖和 NIHSS 评分之间存在显著关联，但基线影像学和临床特征仅能解释个体间变异的一小部分。需要进一步研究影响梗死生长的可测量因素。
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