Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University, 69100, Villeurbanne, France.
Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France.
Diagn Interv Imaging. 2023 Jul-Aug;104(7-8):337-342. doi: 10.1016/j.diii.2023.02.005. Epub 2023 Mar 23.
The purpose of this study was to assess the prognostic value of vascular hyperintensities on FLAIR images (VHF) at admission MRI in patients with acute ischemic stroke (AIS) achieving successful recanalization after mechanical thrombectomy.
Patients with AIS treated by mechanical thrombectomy following admission MRI from the single-center HIBISCUS-STROKE cohort were assessed for eligibility. VHF were categorized using a four-scale classification and were considered poor when grade < 3 (i.e., absence of distal VHF). Recanalization was considered successful when modified thrombolysis in cerebral infarction score was ≥ 2B Functional outcome was considered poor if modified Rankin scale (mRS) at three months was > 2. Univariable and multiple variable logistic regressions were performed to identify factors associated with poor functional outcome despite successful recanalization.
A total of 108 patients were included. There were 65 men and 43 women with a median age of 70.5 years (interquartile range: 55.0, 81.0; age range: 22.0-93.0 years). Among them, 39 subjects (36.1%) had poor functional outcome at three months. Univariable logistic regressions indicated that poorly extended VHF (VHF grade < 3) were associated with a poor functional outcome (P = 0.008) as well as age, hypertension and diabetes, baseline National Institute of Health Stroke Scale (NIHSS) score, pre-stroke mRS, lack of intravenous thrombolysis, cerebral microangiopathy and the presence of microbleeds. Multivariable analysis confirmed that poor VHF status was independently associated with a poor functional outcome (odds ratio [OR], 4.26; 95% confidence interval [CI]: 1.55-12.99; P = 0.007) in combination with hypertension (OR, 1.25; 95% CI: 0.87-1.85; P = 0.02), baseline NIHSS score (OR, 1.09; 95% CI: 1.04-1.20; P = 0.03), pre-stroke mRS (OR, 2.05; 95% CI: 1.07-4.61; P = 0.05) and lack of intravenous thrombolysis (OR, 0.23; 95% CI: 0.08-0.61; P = 0.004).
Poorly extended VHF (grade <3) at admission MRI are associated with a poor functional outcome at three months despite successful recanalization by mechanical thrombectomy.
本研究旨在评估急性缺血性脑卒中（AIS）患者机械取栓后成功再通时入院 MRI 上 FLAIR 图像血管高信号（VHF）的预后价值。
对单中心 HIBISCUS-STROKE 队列中接受机械取栓治疗的 AIS 患者进行评估，以确定其入选资格。使用四级分类法对 VHF 进行分类，当分级<3 级（即无远端 VHF）时，被认为是较差的。改良脑梗死溶栓评分≥2B 级时认为再通成功。功能结局不良定义为三个月时改良 Rankin 量表（mRS）评分>2。采用单变量和多变量逻辑回归分析确定尽管再通成功但与不良功能结局相关的因素。
共纳入 108 例患者，其中 65 例为男性，43 例为女性，中位年龄为 70.5 岁（四分位间距：55.0，81.0；年龄范围：22.0-93.0 岁）。其中 39 例（36.1%）患者在三个月时功能结局不良。单变量逻辑回归分析表明，较差的扩展 VHF（VHF 分级<3）与不良功能结局相关（P=0.008），还与年龄、高血压和糖尿病、基线国立卫生研究院卒中量表（NIHSS）评分、卒中前 mRS、无静脉溶栓、脑微血管病和微出血存在相关。多变量分析证实，较差的 VHF 状态与不良功能结局独立相关（优势比[OR]，4.26；95%置信区间[CI]：1.55-12.99；P=0.007），同时还与高血压（OR，1.25；95%CI：0.87-1.85；P=0.02）、基线 NIHSS 评分（OR，1.09；95%CI：1.04-1.20；P=0.03）、卒中前 mRS（OR，2.05；95%CI：1.07-4.61；P=0.05）和无静脉溶栓（OR，0.23；95%CI：0.08-0.61；P=0.004）相关。
尽管机械取栓成功再通，但入院 MRI 上较差的扩展 VHF（分级<3）与三个月时的不良功能结局相关。
