Neuroradiology Unit, Department of Radiology, Careggi University Hospital, Florence, Italy.
Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Eur J Clin Invest. 2024 Oct;54(10):e14264. doi: 10.1111/eci.14264. Epub 2024 Jun 10.
Hypoperfusion Intensity Ratio (HIR) is associated with collaterals and outcome in acute ischemic stroke (AIS). We investigated whether a combined assessment of HIR and collaterals could provide an added value.
Retrospective single-center study, including AIS patients with large vessel occlusion and endovascular treatment 0-24 h from onset. Predictors of FIV and outcome (90 days modified Rankin Scale 0-1) were investigated with linear and logistic regression respectively. Subjects were stratified in three groups: poor collaterals (grade 0-3) with poor HIR (≥.4), good collaterals (grade 4-5) with poor HIR/poor collaterals with good HIR (<.4) and good collaterals with good HIR.
We included 337 patients (median age 77, 53.1% males), of whom 100 (29.7%) had excellent outcome. One hundred and forty five patients with favourable collateral and HIR profiles had smaller infarct (median poor collaterals with poor HIR 41 mL, good collaterals with poor HIR/poor collaterals with good HIR 21 mL and good collaterals with good HIR 11 mL, p <.001) and higher rates of excellent outcome (poor collaterals with poor HIR 15.7%, good collaterals with poor HIR/poor collaterals with good HIR 26.2% and good collaterals with good HIR 39.3% p =.001). Logistic regression showed that patients with favourable collateral and HIR profiles had the highest odds of good outcome (OR: 3.83, 95% CI 1.62-9.08, p =.002).
Collaterals and HIR are independent predictors of final infarct lesion and outcome in stroke patients and their integration provides an added value. These findings might inform clinical practice and future trials.
低灌注强度比（HIR）与急性缺血性脑卒中（AIS）的侧支循环和预后相关。我们研究了 HIR 和侧支循环的联合评估是否能提供额外的价值。
这是一项回顾性单中心研究，纳入了发病 0-24 小时内行血管内治疗的大血管闭塞性 AIS 患者。分别采用线性和逻辑回归分析预测因子与 FIV 和结局（90 天改良 Rankin 量表 0-1）之间的关系。根据侧支循环分级（0-3 级为差，4-5 级为好）和 HIR（≥.4 为差，<.4 为好）将患者分为三组：差侧支循环伴差 HIR（41ml）、差侧支循环伴好 HIR/差侧支循环伴差 HIR（21ml）和好侧支循环伴好 HIR（11ml）。
共纳入 337 例患者（中位年龄 77 岁，53.1%为男性），其中 100 例（29.7%）预后良好。有 145 例患者具有良好的侧支循环和 HIR 特征，其梗死灶较小（差侧支循环伴差 HIR 组为 41ml，差侧支循环伴好 HIR/差侧支循环伴差 HIR 组为 21ml，好侧支循环伴好 HIR 组为 11ml，p<.001），且预后良好的比例较高（差侧支循环伴差 HIR 组为 15.7%，差侧支循环伴好 HIR/差侧支循环伴差 HIR 组为 26.2%，好侧支循环伴好 HIR 组为 39.3%，p<.001）。逻辑回归显示，具有良好的侧支循环和 HIR 特征的患者具有良好预后的可能性最高（OR：3.83，95%CI 1.62-9.08，p=.002）。
侧支循环和 HIR 是脑卒中患者最终梗死病灶和预后的独立预测因子，两者的联合评估具有额外的价值。这些发现可能为临床实践和未来的试验提供信息。
