Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, Munich, Germany.
Department of Neurology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, Munich, Germany.
BMC Neurol. 2024 Aug 26;24(1):294. doi: 10.1186/s12883-024-03806-w.
Endovascular therapy for acute ischemic stroke has been shown to be highly effective in selected patients. However, the ideal criteria for patient selection are still debated. It is well known that collateral flow is an important factor, but the assessment is often subjective and time-consuming. Relative cerebral blood volume (rCBV) is a putative indicator of collateral capacity and can be quickly and easily determined by automated quantitative analysis. We investigated the relationship between rCBV of the affected region and clinical outcome in patients with acute ischemic stroke after endovascular therapy.
We conducted a retrospective study on consecutive patients between January 2017 and May 2019. Patients with acute ischemic stroke of the anterior circulation who underwent imaging including computed tomography perfusion and were treated with mechanical thrombectomy (MT) were eligible for inclusion. rCBV was calculated automatically with RAPID software by dividing the average cerebral blood volume (CBV) of the affected region (time-to-maximum (Tmax) > 6 s) by the CBV of the unaffected contralateral side. The primary outcome was determined by the modified Rankin Scale (mRS) after 90 days. Good clinical outcome was defined as mRS ≤ 2. We compared means, performed mono- and multivariate logistical regression and calculated a receiver operating characteristic (ROC)-analysis to determine the ideal cutoff value to predict clinical outcomes.
155 patients were enrolled in this study. 66 patients (42.58%) had good clinical outcomes. Higher rCBV was associated with good clinical outcome (p < 0.001), even after adjustment for the patients' status according to mRS and National Institute of Health Stroke Scale (NIHSS) age and Alberta stroke program early computed tomography score (ASPECTS) at baseline (p = 0.006). ROC-analysis revealed 0.650 (confidence interval: 0.616-0.778) as the optimal cutoff value.
Higher rCBV at baseline is associated with good clinical long-term outcomes in patients with acute ischemic stroke treated by MT. In this study we provide the biggest collective so far that gives evidence that rCBV can be a valuable tool to identify patients who might benefit from MT and are able give a threshold to help to offer patients MT in borderline cases.
血管内治疗急性缺血性脑卒中在特定患者中已被证明非常有效。然而，患者选择的理想标准仍存在争议。众所周知，侧支循环是一个重要因素，但评估通常是主观和耗时的。相对脑血容量(rCBV)是侧支能力的一个假定指标，可以通过自动定量分析快速、轻松地确定。我们研究了接受血管内治疗后急性缺血性脑卒中患者受累区域 rCBV 与临床结局的关系。
我们对 2017 年 1 月至 2019 年 5 月期间连续就诊的患者进行了回顾性研究。符合纳入条件的患者为前循环急性缺血性脑卒中，接受了包括计算机断层灌注成像在内的影像学检查，并接受了机械血栓切除术(MT)治疗。rCBV 通过将受累区域的平均脑血容量(CBV)(Tmax>6s)除以对侧未受累侧的 CBV 自动用 RAPID 软件计算得出。主要结局是 90 天后的改良 Rankin 量表(mRS)评估。良好的临床结局定义为 mRS≤2。我们比较了平均值，进行了单变量和多变量逻辑回归，并计算了受试者工作特征(ROC)分析，以确定预测临床结局的理想截断值。
这项研究共纳入 155 例患者。66 例患者(42.58%)有良好的临床结局。较高的 rCBV 与良好的临床结局相关(p<0.001)，即使在根据 mRS 和美国国立卫生研究院卒中量表(NIHSS)年龄以及基线时的 Alberta 卒中项目早期计算机断层扫描评分(ASPECTS)对患者状态进行调整后(p=0.006)也是如此。ROC 分析显示 0.650(95%置信区间：0.616-0.778)为最佳截断值。
MT 治疗的急性缺血性脑卒中患者基线时 rCBV 较高与良好的临床长期结局相关。在这项研究中，我们提供了迄今为止最大的集合证据，证明 rCBV 可以作为一种有价值的工具，来识别可能从 MT 中获益的患者，并能够为边缘病例中的患者提供 MT 治疗的阈值。
