Department of Neurology, Stanford Hospital, Palo Alto, CA, United States.
Department of Neurology, Stanford Hospital, Palo Alto, CA, United States; Department of Neurology, University of California, San Francisco, United States.
J Stroke Cerebrovasc Dis. 2024 Nov;33(11):107965. doi: 10.1016/j.jstrokecerebrovasdis.2024.107965. Epub 2024 Aug 24.
Recent observations suggest that circadian rhythms are implicated in the timing of stroke onset and the speed of infarct progression. We aimed to replicate these observations in a large, multi-center, automated imaging database.
The RAPID Insights database was queried from 02/01/2016 to 01/31/2022 for patients with perfusion imaging and automated detection of an ischemic stroke due to a presumed large vessel occlusion. Exclusion criteria included: patient age ≤25, mismatch volume of <0 cc, and failure to register a positive value on either relative cerebral blood flow (rCBF) reduction of 38% less than normal or total mismatch volume. Imaging time was subdivided into three epochs: Night: 23:00h-06:59h and Day: 07:00h-14:59h, and Evening: 15:00h-22:59h. Perfusion parameters were defined using standard conventions for core volume, penumbra, and collateral circulation (measured via the Hypoperfusion Intensity Ratio, HIR). Statistical significance was tested using a sinusoidal regression analysis.
A total of 18,137 cases were analyzed. The peak incidence of stroke imaging of patients with LVOs occurred around noon. A sinusoidal pattern was present, with larger ischemic core volumes and higher HIR during the night compared to the day: peak ischemic core volume of 23.4 cc occurred with imaging performed at 3:56 AM (p<0.001) and peak HIR of 0.35 at 3:40 AM (p<0.001).
We found that ischemic core volumes were larger and collateral status worse at nighttime compared to daytime in this large national database. These findings support prior data suggesting that poor collateral recruitment with subsequent larger ischemic stroke volumes may occur at night.
最近的观察结果表明，昼夜节律与中风发作的时间和梗死进展的速度有关。我们旨在在一个大型的多中心自动成像数据库中复制这些观察结果。
从 2016 年 2 月 1 日至 2022 年 1 月 31 日，在 RAPID 洞察数据库中查询了因假定的大血管闭塞而导致的灌注成像和自动检测到的缺血性中风的患者。排除标准包括：患者年龄≤25 岁、不匹配体积<0cc 以及相对脑血流量(rCBF)减少 38%以下或总不匹配体积未登记阳性值。成像时间分为三个时期：夜间：23:00h-06:59h 和白天：07:00h-14:59h，傍晚：15:00h-22:59h。使用核心体积、半影和侧支循环的标准约定（通过低灌注强度比 HIR 测量）定义灌注参数。使用正弦回归分析测试统计学意义。
共分析了 18137 例。LVOs 患者中风成像的高峰发生在中午左右。存在正弦模式，夜间的缺血核心体积较大，HIR 较高：夜间 3:56 AM 进行的成像出现最大缺血核心体积 23.4cc（p<0.001），夜间 3:40 AM 出现最大 HIR 0.35（p<0.001）。
我们发现，在这个大型的全国性数据库中，与白天相比，夜间的缺血核心体积更大，侧支循环状态更差。这些发现支持了先前的数据，表明夜间可能会发生较差的侧支募集和随后更大的缺血性中风体积。
