Luo Jiaqi, Zhao Xiaolin, Xiao Mengxuan, Wei Lihua, Zhu Zhiliang, Li Bingbing, Ji Zhong, Wu Yongming, Lin Zhenzhou, Pan Suyue, Huang Kaibin
Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou City, China.
Department of Neurology, Ganzhou Hospital-Nanfang Hospital, Southern Medical University, Ganzhou City, China.
J Cereb Blood Flow Metab. 2025 Jan;45(1):66-76. doi: 10.1177/0271678X241275763. Epub 2024 Aug 20.
The brain's function of clearance and transport is closely related to the prognosis of acute ischemic stroke (AIS). In this study, we proposed a novel method, clearance rate of contrast extravasation (CROCE), to measure brain clearance and transport function in AIS patients undergoing endovascular therapy (EVT), and examined its association with cerebral edema and functional outcome. We conducted a pooled analysis of AIS patients of anterior circulation large vessel occlusion who underwent EVT in two academic hospitals. Patients who experienced contrast extravasation but not intracerebral hemorrhage following EVT were included. CROCE was defined as the mass of contrast agent cleared per hour on non-contrast CT (NCCT). Among the 215 patients finally included, we found that high CROCE was significantly associated with 90-day favorable functional outcome, and the association retained after adjustment for potential confounders. Different correlation analysis demonstrated a significant correlation between CROCE, cerebral edema, and functional outcome. Further mediation analysis revealed that cerebral edema mediated the effect of CROCE on functional outcome. These results revealed that CROCE may be a promising indicator of brain clearance function for patients who received EVT and had contrast extravasation.
脑的清除和转运功能与急性缺血性卒中（AIS）的预后密切相关。在本研究中，我们提出了一种新方法，即对比剂外渗清除率（CROCE），以测量接受血管内治疗（EVT）的AIS患者的脑清除和转运功能，并研究其与脑水肿及功能结局的相关性。我们对两家学术医院中接受EVT的前循环大血管闭塞的AIS患者进行了汇总分析。纳入EVT后出现对比剂外渗但无脑出血的患者。CROCE定义为非增强CT（NCCT）上每小时清除的对比剂质量。在最终纳入的215例患者中，我们发现高CROCE与90天良好功能结局显著相关，且在调整潜在混杂因素后该相关性依然存在。不同的相关性分析表明CROCE、脑水肿和功能结局之间存在显著相关性。进一步的中介分析显示，脑水肿介导了CROCE对功能结局的影响。这些结果表明，CROCE可能是接受EVT且出现对比剂外渗患者脑清除功能的一个有前景的指标。
