From the Department of Radiology (M.A., T.N.N., A.S., M.M.Q., P.K., A.Z.M., B.N.S.), Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
From the Department of Radiology (M.A., T.N.N., A.S., M.M.Q., P.K., A.Z.M., B.N.S.), Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts.
AJNR Am J Neuroradiol. 2024 Jun 7;45(6):701-707. doi: 10.3174/ajnr.A8222.
Contrast staining is a common finding after endovascular treatment of acute ischemic stroke. It typically occurs in infarcted tissue and is considered an indicator of irreversible brain damage. Contrast staining in noninfarcted tissue has not been systematically investigated. We sought to assess the incidence, risk factors, and clinical significance of contrast staining in noninfarcted tissue after endovascular treatment.
We conducted a retrospective review of consecutive patients who underwent endovascular treatment for anterior circulation large-vessel occlusion acute ischemic stroke. Contrast staining, defined as new hyperdensity on CT after endovascular treatment, was categorized as either contrast staining in infarcted tissue if the stained region demonstrated restricted diffusion on follow-up MR imaging or contrast staining in noninfarcted tissue if the stained region demonstrated no restricted diffusion. Baseline differences between patients with and without contrast staining in noninfarcted tissue were compared. Logistic regression was used to identify independent associations for contrast staining in noninfarcted tissue after endovascular treatment.
Among 194 patients who underwent endovascular treatment for large-vessel occlusion acute ischemic stroke and met the inclusion criteria, contrast staining in infarcted tissue was noted in 52/194 (26.8%) patients; contrast staining in noninfarcted tissue, in 26 (13.4%) patients. Both contrast staining in infarcted tissue and contrast staining in noninfarcted tissue were noted in 5.6% (11/194). Patients with contrast staining in noninfarcted tissue were found to have a higher likelihood of having an ASPECTS of 8-10, to be associated with contrast staining in infarcted tissue, and to achieve successful reperfusion compared with those without contrast staining in noninfarcted tissue. In contrast staining in noninfarcted tissue regions, the average attenuation was 40 HU, significantly lower than the contrast staining in infarcted tissue regions (53 HU). None of the patients with contrast staining in noninfarcted tissue had clinical worsening during their hospital stay. The median discharge mRS was significantly lower in patients with contrast staining in noninfarcted tissue than in those without (3 versus 4; = .018). No independent predictors of contrast staining in noninfarcted tissue were found.
Contrast staining can be seen outside the infarcted tissue after endovascular treatment of acute ischemic stroke, likely attributable to the reversible disruption of the BBB in ischemic but not infarcted tissue. While generally benign, understanding its characteristics is important because it may mimic pathologic conditions such as infarcted tissue and cerebral edema.
对比染色是急性缺血性卒中血管内治疗后的常见表现。它通常发生在梗死组织中，被认为是不可逆脑损伤的标志。然而，非梗死组织中的对比染色尚未得到系统研究。我们旨在评估血管内治疗后非梗死组织中对比染色的发生率、危险因素和临床意义。
我们回顾性分析了连续接受血管内治疗的前循环大血管闭塞性急性缺血性卒中患者。将血管内治疗后 CT 上出现的新高密度影定义为对比染色，如果染色区域在随访 MRI 上显示弥散受限，则为梗死组织中的对比染色；如果染色区域无弥散受限，则为非梗死组织中的对比染色。比较有和无非梗死组织中对比染色患者的基线差异。采用 logistic 回归分析血管内治疗后非梗死组织中对比染色的独立相关因素。
在 194 例接受血管内治疗的大血管闭塞性急性缺血性卒中患者中，52 例（26.8%）患者存在梗死组织中的对比染色，26 例（13.4%）患者存在非梗死组织中的对比染色，5.6%（11/194）患者同时存在梗死组织和非梗死组织中的对比染色。与无非梗死组织中对比染色的患者相比，有非梗死组织中对比染色的患者更可能具有 ASPECTS 评分 8-10，与梗死组织中的对比染色相关，并且实现了成功再灌注。在非梗死组织中的对比染色区域，平均衰减值为 40HU，明显低于梗死组织中的对比染色区域（53HU）。无一例有非梗死组织中对比染色的患者在住院期间出现临床恶化。有非梗死组织中对比染色的患者出院时 mRS 中位数明显低于无对比染色的患者（3 分与 4 分；=.018）。未发现非梗死组织中对比染色的独立预测因素。
急性缺血性卒中血管内治疗后可在梗死组织外出现对比染色，可能归因于缺血但未梗死组织中 BBB 的可逆性破坏。虽然通常是良性的，但了解其特征很重要，因为它可能模仿梗死组织和脑水肿等病理状况。
