Cereda Carlo W, Bianco Giovanni, Mlynash Michael, Yuen Nicole, Qureshi Abid Y, Hinduja Archana, Dehkharghani Seena, Goldman-Yassen Adam E, Hsieh Kevin Li-Chun, Giurgiutiu Dan-Victor, Gibson Dan, Carrera Emmanuel, Alemseged Fana, Faizy Tobias D, Fiehler Jens, Pileggi Marco, Campbell Bruce, Albers Gregory W, Heit Jeremy J
Stroke Center, Neurology, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland.
Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA.
Ann Neurol. 2022 Jan;91(1):23-32. doi: 10.1002/ana.26272. Epub 2021 Dec 3.
Perfusion imaging identifies anterior circulation stroke patients who respond favorably to endovascular thrombectomy (ET), but its role in basilar artery occlusion (BAO) is unknown. We hypothesized that BAO patients with limited regions of severe hypoperfusion (time to reach maximum concentration in seconds [Tmax] > 10) would have a favorable response to ET compared to patients with more extensive regions involved.
We performed a multicenter retrospective cohort study of BAO patients with perfusion imaging prior to ET. We prespecified a Critical Area Perfusion Score (CAPS; 0-6 points), which quantified severe hypoperfusion (Tmax > 10) in cerebellum (1 point/hemisphere), pons (2 points), and midbrain and/or thalamus (2 points). Patients were dichotomized into favorable (CAPS ≤ 3) and unfavorable (CAPS > 3) groups. The primary outcome was a favorable functional outcome 90 days after ET (modified Rankin Scale = 0-3).
One hundred three patients were included. CAPS ≤ 3 patients (87%) had a lower median National Institutes of Health Stroke Scale score (NIHSS; 12.5, interquartile range [IQR] = 7-22) compared to CAPS > 3 patients (13%; 23, IQR = 19-36; p = 0.01). Reperfusion was achieved in 84% of all patients, with no difference between CAPS groups (p = 0.42). Sixty-four percent of reperfused CAPS ≤ 3 patients had a favorable outcome compared to 8% of nonreperfused CAPS ≤ 3 patients (odds ratio [OR] = 21.0, 95% confidence interval [CI] = 2.6-170; p < 0.001). No CAPS > 3 patients had a favorable outcome, regardless of reperfusion. In a multivariate regression analysis, CAPS ≤ 3 was a robust independent predictor of favorable outcome after adjustment for reperfusion, age, and pre-ET NIHSS (OR = 39.25, 95% CI = 1.34->999, p = 0.04).
BAO patients with limited regions of severe hypoperfusion had a favorable response to reperfusion following ET. However, patients with more extensive regions of hypoperfusion in critical brain regions did not benefit from endovascular reperfusion. ANN NEUROL 2022;91:23-32.
灌注成像可识别出对血管内血栓切除术（ET）反应良好的前循环卒中患者，但其在基底动脉闭塞（BAO）中的作用尚不清楚。我们假设，与受累区域更广泛的患者相比，严重灌注不足区域有限（达到最大浓度的时间以秒计[Tmax]＞10）的BAO患者对ET会有良好反应。
我们对ET术前接受灌注成像的BAO患者进行了一项多中心回顾性队列研究。我们预先设定了一个关键区域灌注评分（CAPS；0 - 6分），该评分对小脑（每侧半球1分）、脑桥（2分）以及中脑和/或丘脑（2分）的严重灌注不足（Tmax＞10）进行量化。患者被分为预后良好组（CAPS≤3）和预后不良组（CAPS＞3）。主要结局是ET术后90天的良好功能预后（改良Rankin量表=0 - 3）。
共纳入103例患者。与CAPS＞3的患者（13%；23，四分位间距[IQR]=为19 - （此处原文有误，应为19 - 36））相比，CAPS≤3的患者（87%）的美国国立卫生研究院卒中量表（NIHSS）评分中位数更低（12.5，IQR = 7 - 22；p = 0.01）。所有患者中有84%实现了再灌注，CAPS组之间无差异（p = 0.42）。再灌注的CAPS≤3患者中有64%预后良好，而非再灌注的CAPS≤3患者中这一比例为8%（优势比[OR]=21.0，95%置信区间[CI]=2.6 - 170；p＜0.001）。无论是否再灌注，CAPS＞3的患者均无良好预后。在多变量回归分析中，调整再灌注、年龄和ET术前NIHSS后，CAPS≤3是良好预后的有力独立预测因素（OR = 39.25，95% CI = 1.34 - ＞999，p = 0.04）。
严重灌注不足区域有限的BAO患者对ET后的再灌注有良好反应。然而，关键脑区灌注不足区域更广泛的患者未能从血管内再灌注中获益。《神经病学纪事》2022年；91:23 - 32 。
