Zhou Chun, Cao Yue-Zhou, Jia Zhen-Yu, Zhao Lin-Bo, Lu Shan-Shan, Xu Xiao-Quan, Shi Hai-Bin, Liu Sheng
Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
Interv Neuroradiol. 2024 Sep 8:15910199241270653. doi: 10.1177/15910199241270653.
To investigate the association between perfusion deficit, vessel wall characteristics, and risk of recurrent ischemic events in medically treated patients with chronic symptomatic anterior circulation large vessel occlusion.
We retrospectively reviewed chronic symptomatic patients due to anterior circulation large vessel occlusion in our center. All patients received multiparametric magnetic resonance imaging (including perfusion-weighted imaging and high-resolution vessel wall imaging) within 4 weeks to 3 months after symptom onset. The association between baseline clinical or imaging variables and recurrent ischemic events was assessed in bivariate models and multivariable logistic regression to identify independent predictors of recurrence.
Among 71 enrolled patients, 21.1% (15/71) patients had recurrent ischemic events (nine ischemic strokes and six transient ischemic attacks) during a 2-year follow-up. In bivariate models, hypertension, occlusion with hyperintense signals, the presence of intraluminal thrombus, Tmax >4 s volume, Tmax >6 s volume, Tmax >8 s volume, and Tmax >10 s volume were associated with recurrence (all < 0.05). In multivariate analysis, hypertension ( = 0.039, OR 10.057 (95% CI, 1.123-90.048)), higher deficit volume of Tmax >4 s ( = 0.011, OR 1.012 (95% CI, 1.003-1.021)) and occlusion with hyperintense signal ( = 0.030, OR 6.732 (95% CI, 1.200-37.772)) were still independent predictors of recurrent ischemic events.
Besides hypertension history, higher deficit volume of Tmax >4 s and occlusion with hyperintense signal determined using multiparametric MRI are strongly associated with risk for recurrent ischemic events in medically treated patients with chronic symptomatic anterior circulation large vessel occlusion. Future studies are needed to determine the utility of revascularization strategies in such high-risk patients.
探讨药物治疗的慢性症状性前循环大动脉闭塞患者灌注缺损、血管壁特征与复发性缺血事件风险之间的关联。
我们回顾性分析了本中心因前循环大动脉闭塞导致慢性症状的患者。所有患者在症状发作后4周内至3个月接受多参数磁共振成像（包括灌注加权成像和高分辨率血管壁成像）。在双变量模型和多变量逻辑回归中评估基线临床或影像变量与复发性缺血事件之间的关联，以确定复发的独立预测因素。
在71例纳入的患者中，21.1%（15/71）的患者在2年随访期间发生复发性缺血事件（9例缺血性卒中，6例短暂性脑缺血发作）。在双变量模型中，高血压、高强度信号闭塞、腔内血栓的存在、Tmax>4s体积、Tmax>6s体积、Tmax>8s体积和Tmax>10s体积与复发相关（均P<0.05）。在多变量分析中，高血压（P=0.039，OR 10.057（95%CI，1.123-90.048））、Tmax>4s时更高的缺损体积（P=0.011，OR 1.012（95%CI，1.003-1.021））和高强度信号闭塞（P=0.030，OR 6.732（95%CI，1.200-37.772））仍是复发性缺血事件的独立预测因素。
除高血压病史外，多参数MRI确定的Tmax>4s时更高的缺损体积和高强度信号闭塞与药物治疗的慢性症状性前循环大动脉闭塞患者复发性缺血事件风险密切相关。未来需要开展研究以确定血管重建策略在这类高危患者中的效用。
