Broocks Gabriel, Haupt Wolfgang, McDonough Rosalie, Elsayed Sarah, Flottmann Fabian, Bechstein Matthias, Schön Gerhard, Kniep Helge, Kemmling Andre, Zeleňák Kamil, Fiehler Jens, Hanning Uta, Meyer Lukas
Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Eur J Neurol. 2022 Nov;29(11):3264-3272. doi: 10.1111/ene.15491. Epub 2022 Jul 26.
The benefit of endovascular treatment (EVT) for patients with low Alberta Stroke Program early computed tomography score (ASPECTS) is still ambiguous and is currently being investigated in randomized trials. Computed tomography (CT) perfusion, used to estimate infarct extent and progression, might predict early neurological improvement (ENI) after EVT. We hypothesized that the degree of relative cerebral blood volume (rCBV) reduction is directly associated with ENI in low ASPECTS patients undergoing EVT.
Ischemic stroke patients with ASPECTS ≤ 5 who received multimodal CT and underwent thrombectomy were analyzed. rCBV reduction was defined as the ratio of cerebral blood volume (CBV), measured in the ischemic lesion to contralateral CBV. Complete reperfusion was defined as an expanded Thrombolysis in Cerebral Infarction score 2c-3. The clinical endpoint was ENI at 24 h, defined continuously (National Institutes of Health Stroke Scale [NIHSS] score change from baseline to 24 h) and binarized (NIHSS score at 24 h ≤ 8).
A total of 102 patients were included. Lower rCBV reduction and complete EVT were independently associated with ENI (-11.4 NIHSS points, p = 0.04; -7.3 points, p < 0.0001, respectively). The effect of complete EVT on ENI was directly linked to the degree of rCBV reduction: the probability for binary ENI was +34.6% (p = 0.004) in patients with low rCBV reduction versus +8.2% (p = 0.28) in patients with high rCBV reduction).
In patients with ischemic stroke with low ASPECTS, ENI was directly linked to the degree of rCBV reduction, a potential indicator of ischemia depth in extensive baseline infarction. Lower rCBV reduction was associated with higher probability of ENI after complete reperfusion, suggesting less pronounced lesion progression despite its large extent and hence, a higher susceptibility to EVT.
对于阿尔伯塔卒中项目早期计算机断层扫描评分（ASPECTS）较低的患者，血管内治疗（EVT）的益处仍不明确，目前正在随机试验中进行研究。计算机断层扫描（CT）灌注用于估计梗死范围和进展，可能预测EVT后的早期神经功能改善（ENI）。我们假设，在接受EVT的低ASPECTS患者中，相对脑血容量（rCBV）降低的程度与ENI直接相关。
分析了ASPECTS≤5且接受多模态CT并接受血栓切除术的缺血性卒中患者。rCBV降低定义为缺血病变中测量的脑血容量（CBV）与对侧CBV的比值。完全再灌注定义为扩展的脑梗死溶栓评分2c - 3。临床终点为24小时时的ENI，连续定义（从基线到24小时的美国国立卫生研究院卒中量表[NIHSS]评分变化）并进行二元化（24小时时NIHSS评分≤8）。
共纳入102例患者。较低的rCBV降低和完全EVT与ENI独立相关（分别为NIHSS评分降低11.4分，p = 0.04；降低7.3分，p < 0.0001）。完全EVT对ENI的影响与rCBV降低程度直接相关：rCBV降低程度低的患者二元ENI的概率为 + 34.6%（p = 0.004），而rCBV降低程度高的患者为 + 8.2%（p = 0.28）。
在低ASPECTS的缺血性卒中患者中，ENI与rCBV降低程度直接相关，rCBV降低是广泛基线梗死中缺血深度的潜在指标。较低的rCBV降低与完全再灌注后ENI的较高概率相关，表明尽管病变范围大，但病变进展不明显，因此对EVT的敏感性较高。
