Mujanovic Adnan, Windecker Daniel, Serrallach Bettina, Kurmann Christoph C, Rohner Roman, Auer Elias, Cimflova Petra, Meinel Thomas R, Dorn Franziska, Chapot René, Seiffge David, Piechowiak Eike Immo I, Dobrocky Tomas, Gralla Jan, Fischer Urs, Pilgram-Pastor Sara, Kaesmacher Johannes
Department of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, Bern, Switzerland.
Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
J Neurointerv Surg. 2025 Jan 27. doi: 10.1136/jnis-2024-022253.
Distal occlusions associated with incomplete reperfusion (expanded Thrombolysis in Cerebral Infarction, <eTICI 3) may not reperfuse spontaneously and thus prompt ischemia (ie, persistent hypoperfusion). We aimed to assess whether the recently reported Distal Occlusion Tracker (DOT) sign on immediate non-contrast post-interventional flat-panel detector computed tomography (FPDCT) is associated with persistent hypoperfusion.
Retrospective registry analysis of patients undergoing endovascular therapy between July 2020 and December 2022, with available immediate post-interventional FPDCT and 24 hours follow-up perfusion imaging. Persistent hypoperfusion was defined as a perfusion deficit at 24 hours directly corresponding to the area of incomplete reperfusion on final angiography run. The DOT sign was defined as a punctiform or tubular hyperdense signal increase on FPDCT indicative of a residual occlusion. Association between the DOT sign (present/absent) with the occurrence of persistent hypoperfusion and poor outcome (modified Rankin scale (mRS) score 3-6) was evaluated using logistic regression analysis.
Of 292 patients included (median age 73 years; 47% female), 209 had incomplete reperfusion. Among patients with incomplete reperfusion, 61% had a present DOT sign and 46% had persistent hypoperfusion. In the overall cohort, but also within each eTICI stratum, a present DOT sign was associated with persistent hypoperfusion on 24±12 hours follow-up perfusion imaging (adjusted odds ratio (aOR) 4.8, 95% confidence interval (CI) 2.0 to 12.3 for patients with eTICI 2 a-2c). A present DOT sign was also associated with poor outcome (aOR 2.6, 95% CI 1.1 to 6.2).
Patients with <eTICI 3 and a present DOT sign have a higher likelihood of persistent hypoperfusion and might constitute a subgroup that could particularly benefit from additional reperfusion attempts.
与再灌注不完全相关的远端闭塞（扩展的脑梗死溶栓分级，<eTICI 3级）可能不会自发再灌注，从而导致缺血（即持续性低灌注）。我们旨在评估近期报道的介入后即刻非增强平板探测器计算机断层扫描（FPDCT）上的远端闭塞追踪器（DOT）征是否与持续性低灌注相关。
对2020年7月至2022年12月期间接受血管内治疗的患者进行回顾性注册分析，这些患者有介入后即刻FPDCT及24小时随访灌注成像资料。持续性低灌注定义为24小时时的灌注缺损，与最终血管造影时不完全再灌注区域直接对应。DOT征定义为FPDCT上点状或管状高密度信号增强，提示残余闭塞。采用逻辑回归分析评估DOT征（存在/不存在）与持续性低灌注的发生及不良预后（改良Rankin量表（mRS）评分3 - 6分）之间的关联。
纳入的292例患者（中位年龄73岁；47%为女性）中，209例存在再灌注不完全。在再灌注不完全的患者中，61%有DOT征，46%有持续性低灌注。在整个队列中，以及在每个eTICI分层内，在24±12小时随访灌注成像中，存在DOT征与持续性低灌注相关（eTICI 2a - 2c级患者的调整优势比（aOR）为4.8，95%置信区间（CI）为2.0至12.3）。存在DOT征也与不良预后相关（aOR 2.6，95% CI 1.1至6.2）。
<eTICI 3级且存在DOT征的患者发生持续性低灌注的可能性更高，可能构成一个特别能从额外再灌注尝试中获益的亚组。
