Arba Francesco, Ferretti Simone, Leigh Richard, Fara Andreia, Warach Steven J, Luby Marie, Lees Kennedy R, Dawson Jesse
Stroke Unit, Careggi University Hospital, Florence, Italy.
NEUROFARBA Department, University of Florence, Careggi University Hospital, Florence, Italy.
Transl Stroke Res. 2025 Jun;16(3):925-932. doi: 10.1007/s12975-024-01277-2. Epub 2024 Jul 4.
We investigated relations between cerebral small vessel disease (cSVD) markers and evolution of the ischemic tissue from ischemic core to final infarct in people with acute ischemic stroke treated with intravenous thrombolysis. Data from the Stroke Imaging Repository (STIR) and Virtual International Stroke Trials Archive (VISTA) were used. Any pre-existing lacunar infarcts and white matter hyperintensities (WMH) were assessed on magnetic resonance (MR) before thrombolytic therapy. Acute ischemic core and final infarct volume were then assessed by two independent radiologists. The relationship among baseline markers of cSVD, acute ischemic core volume, final infarct volume, infarct growth (IG = final infarct - ischemic core), and infarct growth ratio (IGR = final infarct/ischemic core) was then assessed using linear and ordinal regression adjusted for age, sex, onset-to-treatment time, and stroke severity. We included 165 patients, mean (± SD) age 69.5 (± 15.7) years, 74 (45%) males, mean (± SD) ischemic core volume 25.48 (± 42.22) ml, final infarct volume 52.06 (± 72.88) ml, IG 26.58 (± 51.02) ml, IGR 8.23 (± 38.12). Seventy (42%) patients had large vessel occlusion, 20 (12%) acute small subcortical infarct. WMHs were present in 131 (79%) and lacunar infarcts in 61 (37%) patients. Final infarct volumes were 53.8 ml and 45.2 ml (WMHs/no WMHs), p = 0.139, and 24.6 ml and 25.9 ml (lacunar infarcts/no lacunar infarcts), p = 0.842. In linear and ordinal regression analyses, presence of lacunar infarcts was associated with smaller IG (β = - 0.17; p = 0.024; cOR = 0.52; 95%CI = 0.28-0.96, respectively) and WMHs were associated with smaller IGR (β = - 0.30; p = 0.004; cOR = 0.27; 95%CI = 0.11-0.69, respectively). In people with acute ischemic stroke treated with intravenous thrombolysis, cSVD features were associated with smaller growth of the acute ischemic area, suggesting less salvageable tissue at time of reperfusion therapy.
我们研究了接受静脉溶栓治疗的急性缺血性脑卒中患者脑小血管病（cSVD）标志物与缺血组织从缺血核心到最终梗死灶演变之间的关系。使用了来自卒中影像数据库（STIR）和虚拟国际卒中试验档案库（VISTA）的数据。在溶栓治疗前通过磁共振（MR）评估任何既往存在的腔隙性梗死和白质高信号（WMH）。然后由两名独立的放射科医生评估急性缺血核心和最终梗死灶体积。接着使用针对年龄、性别、发病至治疗时间和卒中严重程度进行调整的线性回归和有序回归，评估cSVD的基线标志物、急性缺血核心体积、最终梗死灶体积、梗死灶生长（IG = 最终梗死灶 - 缺血核心）和梗死灶生长率（IGR = 最终梗死灶/缺血核心）之间的关系。我们纳入了165例患者，平均（±标准差）年龄69.5（±15.7）岁，74例（45%）为男性，平均（±标准差）缺血核心体积25.48（±42.22）ml，最终梗死灶体积52.06（±72.88）ml，IG为26.58（±51.02）ml，IGR为8.23（±38.12）。70例（42%）患者存在大血管闭塞，20例（12%）为急性小皮质下梗死。131例（79%）患者存在WMH，61例（37%）患者存在腔隙性梗死。最终梗死灶体积在有/无WMH患者中分别为53.8 ml和45.2 ml，p = 0.139，在有/无腔隙性梗死患者中分别为24.6 ml和25.9 ml，p = 0.842。在线性回归和有序回归分析中，腔隙性梗死的存在与较小的IG相关（β = -0.17；p = 0.024；cOR = 0.52；95%CI分别为0.28 - 0.96），WMH与较小的IGR相关（β = -0.30；p = 0.004；cOR = 0.27；95%CI分别为0.11 - 0.69）。在接受静脉溶栓治疗的急性缺血性脑卒中患者中，cSVD特征与急性缺血区域较小的生长相关，提示再灌注治疗时可挽救的组织较少。
