Neurology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
Toulouse Neuro Imaging Center, Toulouse, France.
J Neurointerv Surg. 2022 Nov;14(11):1051-1055. doi: 10.1136/neurintsurg-2021-017946. Epub 2021 Nov 8.
Half of the patients with large vessel occlusion (LVO)-related acute ischemic stroke (AIS) who undergo endovascular reperfusion are dead or dependent at 3 months. We hypothesize that in addition to established prognostic factors, baseline imaging profile predicts outcome among reperfusers.
Consecutive patients receiving endovascular treatment (EVT) within 6 hours after onset with Thrombolysis In Cerebral Infarction (TICI) 2b, 2c and 3 revascularization were included. Poor outcome was defined by a modified Rankin scale (mRS) 3-6 at 90 days. No mismatch (NoMM) profile was defined as a mismatch (MM) ratio ≤1.2 and/or a volume <10 mL on pretreatment imaging.
187 patients were included, and 81 (43%) had a poor outcome. Median delay from stroke onset to the end of EVT was 259 min (IQR 209-340). After multivariable logistic regression analysis, older age (OR 1.26, 95% CI 1.06 to 1.5; p=0.01), higher National Institutes of Health Stroke Scale (NIHSS) (OR 1.15, 95% CI 1.06 to 1.25; p<0.0001), internal carotid artery (ICA) occlusion (OR 3.02, 95% CI 1.2 to 8.0; p=0.021), and NoMM (OR 4.87, 95% CI 1.09 to 22.8; p=0.004) were associated with poor outcome. In addition, post-EVT hemorrhage (OR 3.64, 95% CI 1.5 to 9.1; p=0.04) was also associated with poor outcome.
The absence of a penumbra defined by a NoMM profile on baseline imaging appears to be an independent predictor of poor outcome after reperfusion. Strategies aiming to preserve the penumbra may be encouraged to improve these patients' outcomes.
接受血管内再灌注治疗的大动脉闭塞（LVO）相关急性缺血性卒中（AIS）患者中有一半在 3 个月时死亡或依赖。我们假设，除了已建立的预后因素外，基线影像学特征可预测再灌注患者的结局。
纳入发病后 6 小时内接受血管内治疗（EVT）的连续患者，其血栓切除术脑梗死（TICI）分级为 2b、2c 和 3 级再通。预后不良定义为 90 天时改良 Rankin 量表（mRS）评分 3-6 分。无不匹配（NoMM）特征定义为预处理成像上的不匹配（MM）比值≤1.2 和/或体积<10ml。
共纳入 187 例患者，81 例（43%）预后不良。从卒中发作到 EVT 结束的中位时间为 259 分钟（IQR 209-340）。多变量逻辑回归分析后，年龄较大（OR 1.26，95%CI 1.06-1.5；p=0.01）、更高的国立卫生研究院卒中量表（NIHSS）评分（OR 1.15，95%CI 1.06-1.25；p<0.0001）、颈内动脉（ICA）闭塞（OR 3.02，95%CI 1.2-8.0；p=0.021）和 NoMM（OR 4.87，95%CI 1.09-22.8；p=0.004）与预后不良相关。此外，EVT 后出血（OR 3.64，95%CI 1.5-9.1；p=0.04）也与预后不良相关。
基线影像学上无不匹配（NoMM）特征定义的半影区似乎是再灌注后预后不良的独立预测因素。鼓励采取策略保护半影区可能会改善这些患者的结局。
