与大血管闭塞患者院间转运期间快速梗死进展相关的临床和影像学特征。
Clinical and Imaging Features Associated With Fast Infarct Growth During Interhospital Transfers of Patients With Large Vessel Occlusions.
机构信息
From the Division of Experimental Neurology, Department of Neurosciences (A.W., J.D., R.L.), KU Leuven; Stanford Stroke Center (A.W., P.S., N.Y., M.M., S.K., S.C., G.W.A., M.G.L.), Palo Alto, CA; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), U1266, INSERM; Neurology Department (P.S.), Hôpital Fondation A. de Rothschild, Paris, France; Radiology Department (J.J.H.), Stanford University, Palo Alto, CA; and Department of Neurology (J.D., R.L.), University Hospitals Leuven, Belgium.
出版信息
Neurology. 2024 Sep 24;103(6):e209814. doi: 10.1212/WNL.0000000000209814. Epub 2024 Aug 22.
BACKGROUND AND OBJECTIVES
Acute ischemic stroke patients with a large vessel occlusion (LVO) who present to a primary stroke center (PSC) often require transfer to a comprehensive stroke center (CSC) for thrombectomy. Not much is known about specific characteristics at the PSC that are associated with infarct growth during transfer. Gaining more insight into these features could aid future trials with cytoprotective agents targeted at slowing infarct growth. We aimed to identify baseline clinical and imaging characteristics that are associated with fast infarct growth rate (IGR) during interhospital transfer.
METHODS
We included patients from the CT Perfusion to Predict Response to Recanalization in Ischemic Stroke Project, a prospective multicenter study. Patients with an anterior circulation LVO who were transferred from a PSC to a CSC for consideration of thrombectomy were eligible if imaging criteria were fulfilled. A CT perfusion (CTP) needed to be obtained at the PSC followed by an MRI at the CSC, before consideration of thrombectomy. The interhospital IGR was defined as the difference between the infarct volumes on MRI and CTP, divided by the time between the scans. Multivariable logistic regression was used to determine characteristics associated with fast IGR (≥5 mL/h).
RESULTS
A total of 183 patients with a median age of 74 years (interquartile range 61-82), of whom 99 (54%) were male and 82 (45%) were fast progressors, were included. At baseline, fast progressors had a higher NIH Stroke Scale score (median 16 vs 13), lower cerebral blood volume index (median 0.80 vs 0.89), more commonly poor collaterals on CT angiography (35% vs 13%), higher hypoperfusion intensity ratios (HIRs) (median 0.51 vs 0.34), and larger core volumes (median 11.80 mL vs 0.00 mL). In multivariable analysis, higher HIR (adjusted odds ratio [aOR] for every 0.10 increase 1.32 [95% CI 1.10-1.59]) and larger core volume (aOR for every 10 mL increase 1.54 [95% CI 1.20-2.11]) remained independently associated with fast IGR.
DISCUSSION
Fast infarct growth during interhospital transfer of acute stroke patients is associated with imaging markers of poor collaterals on baseline imaging. These markers are promising targets for patient selection in cytoprotective trials aimed at reducing interhospital infarct growth.
背景与目的
就诊于初级卒中中心（PSC）的伴有大血管闭塞（LVO）的急性缺血性卒中患者常需要转至综合性卒中中心（CSC）进行血栓切除术。对于在转院过程中与梗死体积增加相关的 PSC 特定特征，我们知之甚少。更深入地了解这些特征可能有助于未来针对保护细胞免受损伤以减缓梗死体积增加的试验。我们旨在确定与转院过程中梗死快速增长率（IGR）相关的基线临床和影像学特征。
方法
我们纳入了 CT 灌注以预测缺血性卒中再灌注反应项目（CT Perfusion to Predict Response to Recanalization in Ischemic Stroke Project）的前瞻性多中心研究中的患者。如果符合影像学标准，前循环 LVO 患者从 PSC 转至 CSC 以考虑血栓切除术，即符合入选条件。需要在 PSC 获得 CT 灌注（CTP），然后在 CSC 获得 MRI，之后再考虑进行血栓切除术。院间 IGR 定义为 MRI 和 CTP 上的梗死体积之间的差异，除以扫描之间的时间。多变量逻辑回归用于确定与快速 IGR（≥5 mL/h）相关的特征。
结果
共纳入 183 例中位年龄 74 岁（四分位距 61-82）的患者，其中 99 例（54%）为男性，82 例（45%）为快速进展者。基线时，快速进展者 NIH 卒中量表评分较高（中位数 16 分比 13 分），脑血容量指数较低（中位数 0.80 比 0.89），CT 血管造影上通常侧支循环较差（35%比 13%），低灌注强度比（HIR）较高（中位数 0.51 比 0.34），核心体积较大（中位数 11.80 mL 比 0.00 mL）。多变量分析显示，较高的 HIR（每增加 0.10 的调整优势比 [aOR] 为 1.32 [95% CI 1.10-1.59]）和较大的核心体积（每增加 10 mL 的 aOR 为 1.54 [95% CI 1.20-2.11]）与快速 IGR 独立相关。
讨论
急性卒中患者在院间转院过程中梗死快速增长与基线影像学上的侧支循环不良的影像学标志物相关。这些标志物是针对旨在减少院间梗死增长的保护细胞免受损伤试验的有希望的患者选择靶点。
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