Lu Ping, Cui Lingyun, Zhao Xingquan
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, People's Republic of China.
Heliyon. 2023 Sep 3;9(9):e19758. doi: 10.1016/j.heliyon.2023.e19758. eCollection 2023 Sep.
Malignant cerebral edema (MCE) is often associated with severe physical disability and a high mortality rate. The current prediction of MCE is focused on infarct volume, and tools are relatively lacking. The prominent veins sign (PVS-SWI) is considered a marker of severely impaired tissue perfusion. This study aimed to determine whether PVS-SWI is associated with early-onset MCE. Patients with acute ischemic stroke (AIS) due to severe large arterial stenosis or occlusion (SLASO) from June 2018 to June 2020 were included. The ASPECTS score assessed the extent of PVS-SWI, and 4-10 was defined as a positive group. The primary outcome was MCE, defined as the deterioration of neurological function and midline structural excursions of >5 mm during hospitalization. The secondary outcomes included worsening of the NIHSS by ≥ 2 points, in-hospital death, and death within 1 year after stroke. Logistic regression was used to assess the correlation between PVS-SWI and outcomes. The study included 157 patients， 40 (25.5%) of whom developed MCE. PVS-SWI was more prevalent in patients who developed MCE (75.0% vs 45.3%; P = 0.001). In multivariate regression analysis, PVS-SWI was an independent predictor of MCE development in patients with larger infarct sizes (OR: 4.00， 95%CI: 1.54-10.35，p = 0.004). In patients with small infarct sizes, PVS-SWI was an independent predictor of a worsening NIHSS of ≥2(OR: 11.13， 95%CI: 2.26-54.89， p = 0.003）. However, PVS-SWI was not associated with death. The main finding of our study was that in patients with larger infarct sizes, a positive PVS-SWI increased the risk of developing MCE. In these patients, more interventions may be needed.
恶性脑水肿（MCE）常伴有严重的身体残疾和高死亡率。目前对MCE的预测主要集中在梗死体积上，且相关工具相对匮乏。显著静脉征（PVS-SWI）被认为是组织灌注严重受损的一个标志。本研究旨在确定PVS-SWI是否与早发性MCE相关。纳入了2018年6月至2020年6月因严重大动脉狭窄或闭塞（SLASO）导致急性缺血性卒中（AIS）的患者。ASPECTS评分评估PVS-SWI的范围，4-10分为阳性组。主要结局为MCE，定义为住院期间神经功能恶化和中线结构偏移>5mm。次要结局包括美国国立卫生研究院卒中量表（NIHSS）评分恶化≥2分、住院死亡以及卒中后1年内死亡。采用逻辑回归分析评估PVS-SWI与结局之间的相关性。该研究纳入了157例患者，其中40例（25.5%）发生了MCE。发生MCE的患者中PVS-SWI更为常见（75.0%对45.3%；P = 0.001）。在多变量回归分析中，PVS-SWI是梗死面积较大患者发生MCE的独立预测因素（比值比：4.00，95%置信区间：1.54-10.35，P = 0.004）。在梗死面积较小的患者中，PVS-SWI是NIHSS评分恶化≥2分的独立预测因素（比值比：11.13，95%置信区间：2.26-54.89，P = 0.003）。然而，PVS-SWI与死亡无关。我们研究的主要发现是，在梗死面积较大的患者中，PVS-SWI阳性会增加发生MCE的风险。对于这些患者，可能需要更多的干预措施。
