低灌注强度比预测远端中等血管闭塞取栓成功后的梗死进展。

Hypoperfusion Intensity Ratio Predicts Infarct Growth After Successful Thrombectomy for Distal Medium Vessel Occlusion.

机构信息

Department of Interventional Neuroradiology, Erasme University Hospital, Route de Lennik 808, 1070, Brussels, Belgium.

Department of Radiology, Leuven University Hospital, Leuven, Belgium.

出版信息

Clin Neuroradiol. 2022 Sep;32(3):849-856. doi: 10.1007/s00062-022-01141-6. Epub 2022 Feb 15.

DOI:10.1007/s00062-022-01141-6

PMID:35166857

Abstract

BACKGROUND AND PURPOSE

This study evaluated whether quantitative measurement of collaterals by the hypoperfusion intensity ratio (HIR) on baseline computed tomography perfusion (CTP) correlated with infarct growth and clinical outcome after successful endovascular recanalization of acute ischemic stroke (AIS) caused by primary distal medium vessel occlusions (DMVO).

METHODS

We performed a retrospective analysis of consecutive AIS patients who underwent an initial CTP and were successfully recanalized by thrombectomy (modified thrombolysis In cerebral infarction 2b or 3) for DMVO. We evaluated the association of baseline HIR with infarct growth and clinical outcome.

RESULTS

Between January 2018 and January 2021, 40 patients with an AIS caused by a DMVO were successfully recanalized by MT (65%, 26/40 female, median age 72 years, range 65-83 years). Baseline HIR was strongly correlated with infarct growth after successful recanalization (r = 0.501, p = 0.001). An HIR<0.3 was the optimal threshold for good collaterals using ROC analysis. Patients with HIR ≥ 0.3 had higher infarct growth compared to HIR < 0.3 (23.8 mL, IQR: 9.1-45.1 vs. 7.2 mL, interquartile range (IQR): 4.2-11.7, relative risk 7.9, p = 0.024 in multivariate analysis); their clinical outcome was poorer in univariate analysis (75%, 21/28 patients with a 3 months modified Rankin scale of 0-2 vs. 33%,4/12, p < 0.017, odds ratio (OR) 6.0, 1.37-26.20) but it did not remain significant in multivariate analysis (p = 0.107).

CONCLUSION

Good collaterals on initial CTP assessed by an HIR < 0.3 are associated with less infarct growth after successful recanalization of AIS caused by a DMVO.

摘要

背景与目的

本研究旨在评估在由原发性远端中等血管闭塞（DMVO）引起的急性缺血性卒中（AIS）患者中，基线 CT 灌注（CTP）的低灌注强度比（HIR）定量测量与梗死进展和血管内再通后临床结局的相关性。

方法

我们对连续接受初始 CTP 检查并通过血栓切除术（改良脑梗死溶栓治疗 2b 或 3 级）成功再通 DMVO 的 AIS 患者进行回顾性分析。我们评估了基线 HIR 与梗死进展和临床结局的相关性。

结果

2018 年 1 月至 2021 年 1 月，40 例 DMVO 所致 AIS 患者通过 MT 成功再通（65%，26/40 例为女性，中位年龄 72 岁，范围 65-83 岁）。基线 HIR 与成功再通后的梗死进展呈强相关性（r=0.501，p=0.001）。ROC 分析显示，HIR<0.3 是良好侧支循环的最佳阈值。HIR≥0.3 的患者与 HIR<0.3 的患者相比，梗死进展更高（23.8 mL，IQR：9.1-45.1 比 7.2 mL，IQR：4.2-11.7，相对风险 7.9，p=0.024 在多变量分析中）；在单变量分析中，他们的临床结局较差（75%，28 例患者的 3 个月改良 Rankin 量表评分为 0-2 分，33%，4/12 例，p<0.017，比值比（OR）6.0，1.37-26.20），但在多变量分析中不具有统计学意义（p=0.107）。