大错配轮廓预测接受血管内血栓切除术的急性前循环大血管闭塞患者脑肿胀快速进展。

Large mismatch profile predicts rapidly progressing brain edema in acute anterior circulation large vessel occlusion patients undergoing endovascular thrombectomy.

作者信息

Shao Yanqi, Chen Xinyi, Wang Huiyuan, Shang Yafei, Xu Jie, Zhang Jinshi, Wang Peng, Geng Yu

机构信息

Department of Neurology, Center for Rehabilitation Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China.

Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China.

出版信息

Front Neurol. 2023 Jan 4;13:982911. doi: 10.3389/fneur.2022.982911. eCollection 2022.

DOI:10.3389/fneur.2022.982911

PMID:36686510

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9846046/

Abstract

BACKGROUND

Brain edema is a severe complication in patients with large vessel occlusion (LVO) that can reduce the effectiveness of endovascular therapy (EVT). This study aimed to investigate the association of the perfusion profile at baseline computed tomography (CT) perfusion with rapidly progressing brain edema (RPBE) after EVT in patients with acute anterior LVO.

METHODS

We retrospectively reviewed consecutive data collected from 149 patients with anterior LVO who underwent EVT at our center. Brain edema was measured by the swelling score (0-6 score), and RPBE was defined as the swelling score increased by more than 2 scores within 24 h after EVT. We investigated the effect of RPBE on poor outcomes [National Institute of Health Stroke Scale (NIHSS) score and modified Rankin scale (mRS) score at discharge, the occurrence of hemorrhagic transformation, and mortality rate in the hospital] using the Mann-Whitney -test and chi-square test. A multivariate logistic regression model was used to assess the relationship between perfusion imaging parameters and RPBE occurrence.

RESULTS

Overall, 39 patients (26.2%) experienced RPBE after EVT. At discharge, RPBE was associated with higher NIHSS scores ( = 3.52, 95% CI 2.0-12.0, < 0.001) and higher mRS scores ( = 3.67, 95% CI 0.0-1.0, < 0.001) including the more frequent occurrence of hemorrhagic transformation (χ = 22.17, 95% CI 0.29-0.59, < 0.001) and higher mortality rates in hospital (χ = 9.54, 95% CI 0.06-0.36, = 0.002). Univariate analysis showed that intravenous thrombolysis, baseline ischemic core volume, and baseline mismatch ratio correlated with RPBE (all < 0.05). After dividing the mismatch ratio into quartiles and performing a chi-square test between quartiles, we found that the occurrence of RPBE in Q4 (mismatch ratio > 11.3) was significantly lower than that in Q1 (mismatch ratio ≤ 3.0) ( < 0.05). The result of multivariate logistic regression analysis showed that compared with baseline mismatch ratio <5.1, baseline mismatch ratio between 5.1 and 11.3 (OR:3.85, 95% CI 1.06-14.29, = 0.040), and mismatch ratio >11.3 (OR:5.26, 95% CI 1.28-20.00, = 0.021) were independent protective factors for RPBE.

CONCLUSION

In patients with anterior circulation LVO stroke undergoing successful EVT, a large mismatch ratio at baseline is a protective factor for RPBE, which is associated with poor outcomes.

摘要

背景

脑水肿是大血管闭塞（LVO）患者的一种严重并发症，可降低血管内治疗（EVT）的有效性。本研究旨在探讨急性前循环LVO患者在接受EVT后，基线计算机断层扫描（CT）灌注参数与快速进展性脑水肿（RPBE）之间的关系。

方法

我们回顾性分析了在本中心接受EVT的149例前循环LVO患者的连续数据。采用肿胀评分（0-6分）评估脑水肿情况，RPBE定义为EVT后24小时内肿胀评分增加超过2分。我们使用Mann-Whitney检验和卡方检验研究RPBE对不良预后的影响[出院时美国国立卫生研究院卒中量表（NIHSS）评分、改良Rankin量表（mRS）评分、出血性转化的发生率及住院死亡率]。采用多因素逻辑回归模型评估灌注成像参数与RPBE发生之间的关系。

结果

总体而言，39例患者（26.2%）在EVT后发生了RPBE。出院时，RPBE与较高的NIHSS评分（Z = 3.52，95%CI 2.0-12.0，P < 0.001）和较高的mRS评分（Z = 3.67，95%CI 0.0-1.0，P < 0.001）相关，包括出血性转化的发生率更高（χ² = 22.17，95%CI 0.29-0.59，P < 0.001）和住院死亡率更高（χ² = 9.54，95%CI 0.06-0.36，P = 0.002）。单因素分析显示，静脉溶栓、基线缺血核心体积和基线不匹配率与RPBE相关（均P < 0.05）。将不匹配率分为四分位数并在四分位数之间进行卡方检验后，我们发现第4四分位数（不匹配率>11.3）中RPBE的发生率显著低于第1四分位数（不匹配率≤3.0）（P < 0.05）。多因素逻辑回归分析结果显示，与基线不匹配率<5.1相比，基线不匹配率在5.1至11.3之间（OR：3.85，95%CI 1.06-14.29，P = 0.040）以及不匹配率>11.3（OR：5.26，95%CI 1.28-20.00，P = 0.021）是RPBE的独立保护因素。