Lin Longting, Wang Yueming, Chen Chushuang, Bivard Andrew, Butcher Kenneth, Garcia-Esperon Carlos, Spratt Neil J, Levi Christopher R, Cheng Xin, Dong Qiang, Parsons Mark W
South West Sydney Clinical Campuses, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia.
University of Newcastle, Newcastle, Australia.
J Cereb Blood Flow Metab. 2024 Dec;44(12):1593-1604. doi: 10.1177/0271678X241242911. Epub 2024 Jul 26.
After stroke onset, ischemic brain tissue will progress to infarction unless blood flow is restored. Core growth rate measures the infarction speed from stroke onset. This multicenter cohort study aimed to explore whether core growth rate influences benefit from the reperfusion treatment of endovascular thrombectomy in large ischemic core stroke patients. It identified 134 patients with large core volume >70 mL assessed on brain perfusion image within 9 hours of stroke onset. Of 134 patients, 71 received endovascular thrombectomy and 63 did not receive the treatment. Overall, poor outcomes were frequent, with 3-month severed disability or death rate at 56% in treatment group and 68% in no treatment group (p = 0.156). Patients were then stratified by core growth rate. For patients with 'ultrafast core growth' of >70 mL/hour, rates of poor outcome were especially high in patients without endovascular thrombectomy (n = 13/14, 93%) and relatively lower in patients received the treatment (n = 12/20, 60%, p = 0.033). In contrast, for patients with core growth rate <70 mL/hour, there was not a large difference in poor outcomes between patients with and without the treatment (55% vs. 61%, p = 0.522). Therefore, patients with 'ultrafast core growth' might stand to benefit the most from endovascular treatment.
中风发作后，除非恢复血流，否则缺血性脑组织将进展为梗死。核心生长速率衡量从中风发作开始的梗死速度。这项多中心队列研究旨在探讨核心生长速率是否会影响大缺血核心中风患者血管内血栓切除术再灌注治疗的获益情况。该研究纳入了134例在中风发作后9小时内通过脑灌注成像评估的核心体积>70 mL的大核心体积患者。在这134例患者中，71例接受了血管内血栓切除术，63例未接受该治疗。总体而言，不良结局很常见，治疗组3个月时严重残疾或死亡率为56%，未治疗组为68%（p = 0.156）。然后根据核心生长速率对患者进行分层。对于核心生长速率>70 mL/小时的“超快核心生长”患者，未接受血管内血栓切除术的患者不良结局发生率特别高（n = 13/14，93%），而接受治疗的患者相对较低（n = 12/20，60%，p = 0.033）。相比之下，对于核心生长速率<70 mL/小时的患者，接受治疗和未接受治疗的患者不良结局差异不大（55%对61%，p = 0.522）。因此，“超快核心生长”的患者可能从血管内治疗中获益最大。
