Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan.
Division of Stroke Care Unit National Cerebral and Cardiovascular Center Suita Japan.
J Am Heart Assoc. 2021 Dec 21;10(24):e022880. doi: 10.1161/JAHA.121.022880. Epub 2021 Dec 10.
Background We retrospectively compared early- (<6 hours) versus late- (6-24 hours) presenting patients using perfusion-weighted imaging selection and evaluated clinical/radiographic outcomes. Methods and Results Large vessel occlusion patients treated with mechanical thrombectomy from August 2017 to July 2020 within 24 hours of onset were retrieved from a single-center database. Perfusion-weighted imaging was analyzed by automated software and final infarct volume was measured semi-automatically within 14 days. The primary end point was good outcome (modified Rankin Scale 0-2 at 90 days). Secondary end points were excellent outcome (modified Rankin Scale 0-1 at 90 days), symptomatic intracranial hemorrhage, and death. Clinical characteristics/radiological values including hypoperfusion volume and infarct growth velocity (baseline volume/onset-to-image time) were compared between the groups. Of 1294 patients, 118 patients were included. The median age was 74 years, baseline National Institutes of Health Stroke Scale score was 14, and core volume was 13 mL. The late-presenting group had more female patients (67% versus 31%, respectively; =0.001). No statistically significant differences were seen in good outcome (42% versus 53%, respectively; =0.30), excellent outcome (26% versus 32%, respectively; =0.51), symptomatic intracranial hemorrhage (6.5% versus 4.6%, respectively; =0.74), and death (3.2% versus 5.7%, respectively; =0.58) between the groups. The late-presenting group had more atherothrombotic cerebral infarction (19% versus 6%, respectively; =0.03), smaller hypoperfusion volume (median: 77 versus 133 mL, respectively; =0.04), and slower infarct growth velocity (median: 0.6 versus 5.1 mL/h, respectively; =0.03). Conclusions Patients with early- and late-time windows treated with mechanical thrombectomy by automated perfusion-weighted imaging selection have similar outcomes, comparable with those in randomized trials, but different in infarct growth velocities. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02251665.
背景 我们回顾性比较了使用灌注加权成像选择的早期（<6 小时）和晚期（6-24 小时）发病患者，并评估了临床/影像学结果。
方法和结果 从 2017 年 8 月至 2020 年 7 月，在发病 24 小时内，从一家单中心数据库中检索到接受机械血栓切除术治疗的大血管闭塞患者。通过自动软件分析灌注加权成像，在 14 天内半自动测量最终梗死体积。主要终点是良好结局（90 天改良 Rankin 量表 0-2 分）。次要终点是良好结局（90 天改良 Rankin 量表 0-1 分）、症状性颅内出血和死亡。比较了两组之间的临床特征/影像学值，包括低灌注体积和梗死生长速度（基线体积/发病至成像时间）。在 1294 名患者中，有 118 名患者被纳入。中位年龄为 74 岁，基线国立卫生研究院卒中量表评分为 14 分，核心体积为 13 毫升。晚期发病组女性患者更多（分别为 67%和 31%；=0.001）。两组在良好结局（分别为 42%和 53%；=0.30）、良好结局（分别为 26%和 32%；=0.51）、症状性颅内出血（分别为 6.5%和 4.6%；=0.74）和死亡（分别为 3.2%和 5.7%；=0.58）方面无统计学差异。晚期发病组更常见动脉粥样硬化性脑梗死（分别为 19%和 6%；=0.03）、低灌注体积更小（中位数：分别为 77 毫升和 133 毫升；=0.04）和梗死生长速度更慢（中位数：分别为 0.6 毫升/小时和 5.1 毫升/小时；=0.03）。
结论 接受自动灌注加权成像选择的机械血栓切除术治疗的早期和晚期时间窗患者的结局相似，与随机试验相当，但梗死生长速度不同。
