颅内动脉粥样硬化性急性大血管闭塞的临床及灌注成像特征。
Clinical and perfusion imaging characteristics of acute large vessel occlusion in intracranial atherosclerosis.
机构信息
Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Department of Radiology, Stanford University School of Medicine, Palo Alto, California, USA.
出版信息
J Stroke Cerebrovasc Dis. 2024 Dec;33(12):108024. doi: 10.1016/j.jstrokecerebrovasdis.2024.108024. Epub 2024 Sep 18.
OBJECTIVES
This study aimed to compare clinical and perfusion imaging profiles in acute ischemic stroke with large vessel occlusion (AIS-LVO) between patients with intracranial atherosclerotic disease (ICAD) and non-ICAD who underwent endovascular treatment (EVT).
METHODS
Data from AIS-LVO patients over the anterior circulation undergoing EVT across two stroke centers were retrospectively analyzed. Clinical profiles and perfusion parameters from automated processing of perfusion imaging were compared between ICAD and non-ICAD groups. Ischemic core was defined as relative cerebral blood flow < 30 % on CT perfusion or apparent diffusion coefficient ≤ 620 × 10 mm/s on MR diffusion weighted imaging.
RESULTS
A total of 111 patients were included (46 ICAD, 65 non-ICAD). The ICAD group exhibited a higher male proportion (60.9 % vs. 35.4 %), more M1 segment occlusions (78.3 % vs. 56.9 %), lower atrial fibrillation rates (17.4 % vs. 63.1 %), and lower baseline NIH Stroke Scale (NIHSS) scores (median [IQR]: 13 [8.75-18] vs. 15 [10-21]) at presentation compared to non-ICAD (all p < 0.05). However, there was no difference in NIHSS scores at discharge or in good functional outcomes (modified Rankin Scale 0-2) at 3 months between the two groups. ICAD patients also had smaller median ischemic core volumes (0 [IQR 0-9.7] vs. 4.4 [0-21.6] ml, p = 0.038), smaller median Tmax >6s tissue volulmes (89.3 [IQR 51.1-147.1] vs. 124.4 [80.5-178.6] ml, p = 0.017) and lower median HIR (hypoperfusion intensity ratio defined as Tmax >10s divided by Tmax >6s; 0.28 [IQR 0.09-0.42] vs. 0.44 [0.24-0.60], p = 0.003). Higher baseline NIHSS scores correlated with larger Tmax >6s lesion volumes as well as higher HIR value in non-ICAD patients, but not in ICAD patients.
CONCLUSIONS
In anterior circulation of AIS-LVO, ICAD patients exhibited distinct clinical presentations and perfusion imaging characteristics when compared to non-ICAD patients. Perfusion imaging profiles may serve as indicators for identifying ICAD patients before EVT.
目的
本研究旨在比较接受血管内治疗（EVT）的急性缺血性卒中伴大血管闭塞（AIS-LVO）患者中颅内动脉粥样硬化性疾病（ICAD）与非-ICAD 患者的临床和灌注成像特征。
方法
回顾性分析了在两家卒中中心接受 EVT 的 AIS-LVO 患者的前循环数据。比较了 ICAD 组和非-ICAD 组的临床特征和灌注成像自动处理的灌注参数。缺血核心定义为 CT 灌注相对脑血流量 < 30%或 MR 弥散加权成像表观弥散系数≤620×10 mm/s。
结果
共纳入 111 例患者（46 例 ICAD，65 例非-ICAD）。ICAD 组男性比例较高（60.9% vs. 35.4%），M1 段闭塞比例较高（78.3% vs. 56.9%），房颤发生率较低（17.4% vs. 63.1%），基线 NIHSS 评分较低（中位数[四分位距]：13[8.75-18] vs. 15[10-21]）（均 p < 0.05）。然而，两组患者出院时 NIHSS 评分或 3 个月时良好功能结局（改良 Rankin 量表 0-2）无差异。ICAD 患者的缺血核心体积也较小（0[0-9.7] vs. 4.4[0-21.6]ml，p = 0.038），Tmax>6s 组织体积较小（89.3[51.1-147.1] vs. 124.4[80.5-178.6]ml，p = 0.017），低灌注强度比（定义为 Tmax>10s 与 Tmax>6s 的比值）较低（0.28[0.09-0.42] vs. 0.44[0.24-0.60]，p = 0.003）。非-ICAD 患者中，较高的基线 NIHSS 评分与较大的 Tmax>6s 病变体积以及较高的 HIR 值相关，但在 ICAD 患者中则无相关性。
结论
在前循环 AIS-LVO 中，ICAD 患者的临床表现和灌注成像特征与非-ICAD 患者明显不同。灌注成像特征可作为 EVT 前识别 ICAD 患者的指标。
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