大型缺血核心区的影像学研究及血管内治疗模式：来自日本RESCUE-Japan LIMIT研究的见解

Mode of Imaging Study and Endovascular Therapy for a Large Ischemic Core: Insights From the RESCUE-Japan LIMIT.

作者信息

Sakakibara Fumihiro, Uchida Kazutaka, Yoshimura Shinichi, Sakai Nobuyuki, Yamagami Hiroshi, Toyoda Kazunori, Matsumaru Yuji, Matsumoto Yasushi, Kimura Kazumi, Ishikura Reiichi, Inoue Manabu, Ando Kumiko, Yoshida Atsushi, Tanaka Kanta, Yoshimoto Takeshi, Koge Junpei, Beppu Mikiya, Shirakawa Manabu, Morimoto Takeshi

机构信息

Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan.

Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan.

出版信息

J Stroke. 2023 Sep;25(3):388-398. doi: 10.5853/jos.2023.01641. Epub 2023 Sep 26.

DOI:10.5853/jos.2023.01641

PMID:37813673

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10574299/

Abstract

BACKGROUND AND PURPOSE

Differences in measurement of the extent of acute ischemic stroke using the Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) by non-contrast computed tomography (CT-ASPECTS stratum) and diffusion-weighted imaging (DWI-ASPECTS stratum) may impact the efficacy of endovascular therapy (EVT) in patients with a large ischemic core.

METHODS

The RESCUE-Japan LIMIT (Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan-Large IscheMIc core Trial) was a multicenter, open-label, randomized clinical trial that evaluated the efficacy and safety of EVT in patients with ASPECTS of 3-5. CT-ASPECTS was prioritized when both CT-ASPECTS and DWI-ASPECTS were measured. The effects of EVT on the modified Rankin Scale (mRS) score at 90 days were assessed separately for each stratum.

RESULTS

Among 183 patients, 112 (EVT group, 53; No-EVT group, 59) were in the CT-ASPECTS stratum and 71 (EVT group, 40; No-EVT group, 31) in the DWI-ASPECTS stratum. The common odds ratio (OR) (95% confidence interval) of the EVT group for one scale shift of the mRS score toward 0 was 1.29 (0.65-2.54) compared to the No-EVT group in CT-ASPECTS stratum, and 6.15 (2.46-16.3) in DWI-ASPECTS stratum with significant interaction between treatment assignment and mode of imaging study (P=0.002). There were significant interactions in the improvement of the National Institutes of Health Stroke Scale score at 48 hours (CT-ASPECTS stratum: OR, 1.95; DWIASPECTS stratum: OR, 14.5; interaction P=0.035) and mortality at 90 days (CT-ASPECTS stratum: OR, 2.07; DWI-ASPECTS stratum: OR, 0.23; interaction P=0.008).

CONCLUSION

Patients with ASPECTS of 3-5 on MRI benefitted more from EVT than those with ASPECTS of 3-5 on CT.

摘要

背景与目的

使用阿尔伯塔卒中项目早期计算机断层扫描评分（ASPECTS），通过非增强计算机断层扫描（CT - ASPECTS 层）和扩散加权成像（DWI - ASPECTS 层）来测量急性缺血性卒中范围的差异，可能会影响大缺血核心患者血管内治疗（EVT）的疗效。

方法

RESCUE - 日本 LIMIT（日本超急性脑栓塞血管内挽救恢复 - 大缺血核心试验）是一项多中心、开放标签、随机临床试验，评估了 ASPECTS 为 3 - 5 的患者接受 EVT 的疗效和安全性。当同时测量 CT - ASPECTS 和 DWI - ASPECTS 时，优先采用 CT - ASPECTS。分别评估了各层中 EVT 对 90 天时改良 Rankin 量表（mRS）评分的影响。

结果

183 例患者中，112 例（EVT 组 53 例，非 EVT 组 59 例）在 CT - ASPECTS 层，71 例（EVT 组 40 例，非 EVT 组 31 例）在 DWI - ASPECTS 层。与 CT - ASPECTS 层的非 EVT 组相比，EVT 组 mRS 评分向 0 移动一个等级的共同优势比（OR）（95%置信区间）为 1.29（0.65 - 2.54），而在 DWI - ASPECTS 层为 6.15（2.46 - 16.3），治疗分配与影像学研究方式之间存在显著交互作用（P = 0.002）。在 48 小时时美国国立卫生研究院卒中量表评分的改善（CT - ASPECTS 层：OR，1.95；DWI - ASPECTS 层：OR，14.5；交互作用 P = 0.035）和 90 天时的死亡率（CT - ASPECTS 层：OR，2.07；DWI - ASPECTS 层：OR，0.23；交互作用 P = 0.008）方面存在显著交互作用。