Department of Neurology, Nanjing Drum Tower Hospital Clinical College of Xuzhou Medical University, Nanjing, China.
Department of Neurology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China; Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, China.
Brain Res. 2025 Jan 1;1846:149231. doi: 10.1016/j.brainres.2024.149231. Epub 2024 Sep 11.
To investigate the correlation and predictive value of white matter hyperintensity (WMH) burden in conjunction with collateral circulation during mechanical thrombectomy (MT) for acute anterior circulation occlusion.
A database comprising consecutive registrations of patients who underwent mechanical thrombectomy for acute anterior circulation large vessel occlusive cerebral infarction at Nanjing Drum Tower Hospital from January 2018 to December 2021 was analyzed. Collateral circulation was assessed using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) scoring criteria. The good collateral group included ASITN/SIR grades 3 and 4, while the poor collateral group included grades 1 and 2. Additionally, white matter hyperintensity burden was evaluated using white matter hyperintensity volume and the Fazekas scoring system. A favorable functional outcome was defined as a modified Rankin scale (mRS) of 0-2 at 90 days. Multivariable logistic regression analyses and Spearman correlation analysis were employed to assess the correlation between white matter hyperintensity burden and unfavorable outcomes in mechanical thrombectomy.
A total of 123 patients who underwent mechanical thrombectomy for acute anterior circulation occlusion were included (56.9 % male). Favorable outcomes were observed in 45.5 % (56/123) of cases. Those with a low ASITN/SIR scale (r = -1.33, 95 % CI: 0.26 (0.09-0.78), P=0.01; cutoff value = 2.5), low low-density lipoprotein cholesterol (LDL-C) level (r = -1.00, 95 % CI: 0.37 (0.15-0.92), P=0.03; cutoff value = 2.26), and high white matter hyperintense volume (r = 0.28, 95 % CI: 1.33 (1.03-1.71), P=0.03; cutoff value = 10.03) were more likely to experience unfavorable outcomes. Moreover, when compared to ASITN/SIR scale (AUC=89.6, 95 % CI: 0.09-0.78) and LDL level (AUC=62.8, 95 % CI: 0.15-0.92), white matter hyperintense volume demonstrated greater accuracy in predicting poor outcomes (AUC=94.4, 95 % CI: 1.03-1.71). Importantly, white matter hyperintense volume showed a positive correlation with the modified Rankin Scale (mRS) Score (r = 0.8289, P<0.0001). In brief, the burden of white matter hyperintensity is negatively correlated with collateral circulation in mechanical thrombectomy for acute anterior circulation occlusion.
The higher the burden of white matter hyperintensity, the worse the collateral circulation in mechanical thrombectomy for acute anterior circulation occlusion. The combination of high white matter hyperintensity volume and poor collateral circulation enhances might predict a worse clinical outcome of mechanical thrombectomy with acute anterior circulation occlusion.
探讨急性前循环闭塞机械取栓术时脑白质高信号（WMH）负荷与侧支循环的相关性及其预测价值。
对 2018 年 1 月至 2021 年 12 月在南京鼓楼医院接受机械取栓治疗的急性前循环大血管闭塞性脑梗死患者的连续登记资料进行分析。侧支循环采用美国介入治疗与治疗神经放射学学会/介入放射学学会（ASITN/SIR）评分标准进行评估。良好侧支循环组包括 ASITN/SIR 3 级和 4 级，而不良侧支循环组包括 1 级和 2 级。此外，WMH 负荷采用脑白质高信号体积和 Fazekas 评分系统进行评估。90 天时改良 Rankin 量表（mRS）评分为 0-2 定义为良好功能结局。采用多变量逻辑回归分析和 Spearman 相关性分析评估脑白质高信号负荷与机械取栓不良结局之间的相关性。
共纳入 123 例接受急性前循环闭塞机械取栓治疗的患者（56.9%为男性）。56.9%（56/123）的患者预后良好。ASITN/SIR 评分较低（r=-1.33，95%CI：0.26（0.09-0.78），P=0.01；临界值=2.5）、低密度脂蛋白胆固醇（LDL-C）水平较低（r=-1.00，95%CI：0.37（0.15-0.92），P=0.03；临界值=2.26）和脑白质高信号体积较高（r=0.28，95%CI：1.33（1.03-1.71），P=0.03；临界值=10.03）的患者更可能出现不良结局。此外，与 ASITN/SIR 评分（AUC=89.6，95%CI：0.09-0.78）和 LDL 水平（AUC=62.8，95%CI：0.15-0.92）相比，脑白质高信号体积在预测不良结局方面具有更高的准确性（AUC=94.4，95%CI：1.03-1.71）。重要的是，脑白质高信号体积与改良 Rankin 量表（mRS）评分呈正相关（r=0.8289，P<0.0001）。总之，急性前循环闭塞机械取栓术中脑白质高信号负荷与侧支循环呈负相关。
急性前循环闭塞机械取栓术中脑白质高信号负荷越高，侧支循环越差。脑白质高信号体积较高和侧支循环不良相结合可能预测急性前循环闭塞机械取栓的更差临床结局。
