Zamarud Aroosa, Yuen Nicole, Wouters Anke, Mlynash Michael, Hugdal Stephen M, Seners Pierre, Kesten Jamie, Yedavalli Vivek, Faizy Tobias D, Albers Gregory W, Lansberg Maarten G, Heit Jeremy J
Department of Radiology, Stanford University School of Medicine, Stanford, California, USA.
Department of Neurology, Stanford University School of Medicine, Stanford, California, USA.
J Neurointerv Surg. 2025 Jan 26. doi: 10.1136/jnis-2024-022064.
Hyperintense acute reperfusion marker (HARM) refers to delayed enhancement in the subarachnoid or subpial space on post-contrast fluid attenuated inversion recovery (FLAIR) images. HARM is a measure of blood-brain barrier breakdown, which has been correlated with poor outcomes in patients with acute ischemic stroke with large vessel occlusion (AIS-LVO). We hypothesized that unfavorable venous outflow (VO) would be correlated with HARM after thrombectomy treatment of AIS-LVO.
To determine whether poor VO is associated with HARM on follow-up MRI after stroke in patients with AIS-LVO.
Patients with AIS-LVO from the prospective CRISP2 and DEFUSE2 studies with a baseline CT angiography (CTA) scan and a follow-up MRI with FLAIR sequence were screened for enrollment. VO was measured on the baseline CTA scan using the cortical venous opacification score (COVES). HARM was determined on FLAIR sequences at the follow-up MRI. The primary outcome was the occurrence of HARM between those with good VO (VO+; COVES 3-6) and bad VO (VO-; COVES 0-2).
121 patients were included; 60.3% (n=73) had VO+ and 39.7% (n=48) had VO-. Patients with VO- had higher presentation National Institutes of Health Stroke Scale scores (18 (IQR 12-20) vs 12 (IQR 8-16) in VO+; P<0.001). Middle cerebral artery M1 segment occlusions were more common in VO- patients (65% vs 43% VO+; P=0.028). VO- patients also had a larger pre-treatment ischemic core (23 (4-44) mL vs 12 (3-22) mL in VO+; P=0.049) and Tmax >6 s volumes (105 (72-142) mL vs 66 (35-95) mL in VO+; P<0.001). VO- patients were more likely to develop HARM after thrombectomy (31% vs 10% in VO+; P=0.003). On multivariable regression analysis, VO- (OR=3.6 (95% CI 1.2 to 10.6); P=0.02) and the presence of any ICH (OR=3.6 (95% CI 1.2 to 10.5); P=0.02) were independently associated with the occurrence of HARM.
In patients with AIS-LVO, VO- correlated with HARM on post-thrombectomy MRI.
高强度急性再灌注标志物（HARM）是指对比剂增强后的液体衰减反转恢复（FLAIR）图像上蛛网膜下腔或软脑膜下间隙的延迟强化。HARM是血脑屏障破坏的一种指标，与急性大血管闭塞性缺血性卒中（AIS-LVO）患者的不良预后相关。我们推测，AIS-LVO患者行血栓切除术治疗后，不良的静脉流出（VO）与HARM相关。
确定AIS-LVO患者卒中后随访MRI上不良的VO是否与HARM相关。
对前瞻性CRISP2和DEFUSE2研究中具有基线CT血管造影（CTA）扫描及FLAIR序列随访MRI的AIS-LVO患者进行筛选以纳入研究。使用皮质静脉显影评分（COVES）在基线CTA扫描上测量VO。在随访MRI的FLAIR序列上确定HARM。主要结局是VO良好（VO+；COVES 3-6）和VO不良（VO-；COVES 0-2）患者中HARM的发生情况。
纳入121例患者；60.3%（n=73）为VO+，39.7%（n=48）为VO-。VO-患者的美国国立卫生研究院卒中量表初始评分更高（VO+组为12（四分位间距8-16），VO-组为18（四分位间距12-20）；P<0.001）。大脑中动脉M1段闭塞在VO-患者中更常见（VO-组为65%，VO+组为43%；P=0.028）。VO-患者治疗前的缺血核心也更大（VO+组为12（3-22）mL，VO-组为23（4-44）mL；P=0.049），且Tmax>6秒的体积更大（VO+组为66（35-95）mL；VO-组为105（72-142）mL；P<0.001）。VO-患者血栓切除术后更易发生HARM（VO+组为10%，VO-组为31%；P=0.003）。多变量回归分析显示，VO-（比值比=3.6（95%置信区间1.2至10.6）；P=0.02）和任何脑出血的存在（比值比=3.6（95%置信区间1.2至10.5）；P=0.02）与HARM的发生独立相关。
在AIS-LVO患者中，VO-与血栓切除术后MRI上的HARM相关。
