Zhou Ying, He Yaode, Yan Shenqiang, Chen Lin, Zhang Ruoxia, Xu Jinjin, Hu Haitao, Liebeskind David S, Lou Min
Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (Y.Z., Y.H., S.Y., L.C., R.Z., J.X., H.H., M.L.).
University of California-Los Angeles Stroke Center (D.S.L.).
Stroke. 2023 Jan;54(1):96-104. doi: 10.1161/STROKEAHA.122.039337. Epub 2022 Nov 11.
The existence of cerebral reperfusion injury in human beings remains controversial. Thus, we aimed to explore the presence of reperfusion injury in acute ischemic stroke patients with recanalization after mechanical thrombectomy and analyzed its impact on neurological outcome.
We reviewed our prospectively collected database CIPPIS (Comparison Influence to Prognosis of CTP and MRP in AIS Patients, NCT03367286), and enrolled anterior circulation large artery occlusion patients with recanalization after mechanical thrombectomy who underwent (1) computed tomography (CT) perfusion on admission and immediately after recanalization to determine reperfusion region, and (2) CT and/or magnetic resonance imaging (MRI) immediately and 24 hours after recanalization to determine lesion areas. The expansion of lesion between recanalization and 24 hours within reperfusion region was potentially caused by reperfusion, thus termed as radiological observed reperfusion injury (RORI). Based on the imaging modality immediately after recanalization, RORI was further divided into RORI and RORI. We first included a small cohort who had performed both CT and MRI immediately after recanalization to validate the consistency between RORI and RORI (Study 1). Then the association with RORI and poor outcome, defined as 3-month modified Rankin Scale score of 3 to 6, was explored in a larger cohort (Study 2).
Study 1 included 23 patients and good consistency was found between RORI and RORI (intraclass correlation=0.97, <0.001). Among 226 patients included in Study 2, a total of 106 (46.9%) were identified with RORI. The ratio of RORI to reperfusion region was 30.1 (16.2, 51.0)% and was independently associated with poor outcome (odds ratio=1.55 per 10% [95% CI' 1.30-1.84]; <0.001).
Our findings suggested that RORI was relatively frequent in stroke patients with recanalization after mechanical thrombectomy and associated with poor outcome despite successful recanalization.
URL: https://www.
gov; Unique identifier: NCT03367286.
人类脑再灌注损伤的存在仍存在争议。因此，我们旨在探讨机械取栓术后再通的急性缺血性卒中患者中再灌注损伤的存在情况，并分析其对神经功能结局的影响。
我们回顾了前瞻性收集的数据库CIPPIS（急性缺血性卒中患者CT灌注与MRP对预后的比较影响，NCT03367286），纳入机械取栓术后再通的前循环大动脉闭塞患者，这些患者接受了以下检查：（1）入院时及再通后立即进行计算机断层扫描（CT）灌注以确定再灌注区域；（2）再通后立即及24小时进行CT和/或磁共振成像（MRI）以确定病变区域。再灌注区域内在再通与24小时之间病变的扩大可能是由再灌注引起的，因此称为影像学观察到的再灌注损伤（RORI）。根据再通后立即进行的成像方式，RORI进一步分为RORI和RORI。我们首先纳入了一个小队列，这些患者在再通后立即进行了CT和MRI检查，以验证RORI和RORI之间的一致性（研究1）。然后在一个更大的队列中探讨RORI与不良结局（定义为3个月改良Rankin量表评分为3至6分）之间的关联（研究2）。
研究1纳入了23例患者，发现RORI和RORI之间具有良好的一致性（组内相关系数=0.97，<0.001）。在研究2纳入的226例患者中，共有106例（46.9%）被确定存在RORI。RORI占再灌注区域的比例为30.1（16.2，51.0）%，且与不良结局独立相关（比值比=每10%为1.55 [95%置信区间：1.30 - 1.84]；<0.001）。
我们的研究结果表明，在机械取栓术后再通的卒中患者中，RORI相对常见，且尽管再通成功，但与不良结局相关。
网址：https://www.
gov；唯一标识符：NCT03367286。
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