Valls Carbó Adrián, Palomar Alicia, Laredo Carlos, Werner Mariano, Dorado Laura, Remollo Sebastià, Munuera Josep, Puig Josep, Silva Yolanda, Pérez de la Ossa Natalia, Gomis Meritxell, Bustamante Alejandro, Castaño Carlos, Muñoz Lucía, Domenech Sira, Terceño Mikel, Millán Mònica, Hernández-Pérez María
Department of Neuroscience, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
Canon Medical Systems Spain and Portugal, Barcelona, Spain.
Front Neurol. 2025 Feb 27;16:1478240. doi: 10.3389/fneur.2025.1478240. eCollection 2025.
Half of the patients who undergo successful recanalization after endovascular treatment (EVT) experience poor clinical outcomes. Impaired microvascular reperfusion (IMR) may explain this lack of improvement, but its frequency and clinical significance remain unclear. The study aims to describe the frequency and associated factors of IMR.
We conducted a study on a cohort of patients with anterior large artery occlusion, treated with EVT at a single center, who achieved mTICI ≥2C. Perfusion MRI was obtained at arrival, up to 2 h after EVT (post-EVT MRI), and on day 5. IMR was observed only on the post-EVT relative cerebral blood volume (rCBV) maps as voxels within the follow-up ischemic lesion, exhibiting a > 15% asymmetry compared to a mirror homolog, in the absence of internal carotid occlusion, hemorrhagic transformation, or arterial reocclusion. Patients with an IMR volume greater than 5 mL were defined as having significant IMR. IMR was analyzed as a binary variable (presence/absence using the 5 mL cut-off) and by total and relative volume.
IMR was present in 8 out of 33 patients (24.2%), with 4 out of 11 (36.4%) having mTICI 2C, and 4 out of 22 (18.2%) having mTICI 3. After adjustment for relevant variables, absolute and relative IMR volumes were associated with higher National Institutes of Health Stroke Scale (NIHSS) scores at 5 days (adjusted beta =0.50 [0.05, 0.96], = 0.03) and at 24 h (adjusted beta = 0.11 [0.02, 0.19], = 0.01). No independent associations were found between IMR and the 90-day modified Rankin Scale (mRS).
IMR is present in one-quarter of patients and is associated with worse early neurological outcomes.
接受血管内治疗（EVT）后成功再通的患者中，有一半的患者临床预后较差。微血管再灌注受损（IMR）可能是导致预后改善不佳的原因，但IMR的发生频率及其临床意义仍不明确。本研究旨在描述IMR的发生频率及其相关因素。
我们对一组在单一中心接受EVT治疗、实现改良脑梗死溶栓（mTICI）≥2C的大脑前动脉闭塞患者进行了研究。在患者入院时、EVT后2小时内（EVT后MRI）以及第5天进行灌注磁共振成像（MRI）。仅在EVT后的相对脑血容量（rCBV）图上观察IMR，即在随访缺血性病变内与镜像同源区域相比显示>15%不对称的体素，前提是不存在颈内动脉闭塞、出血性转化或动脉再闭塞。IMR体积大于5 mL的患者被定义为存在显著IMR。IMR作为二元变量（根据5 mL的临界值判断存在与否）以及根据总体积和相对体积进行分析。
33例患者中有8例（24.2%）存在IMR，其中11例mTICI 2C的患者中有4例（36.4%）存在IMR，22例mTICI 3的患者中有4例（18.2%）存在IMR。在对相关变量进行校正后，IMR的绝对体积和相对体积与第5天较高的美国国立卫生研究院卒中量表（NIHSS）评分相关（校正β =0.50 [0.05, 0.96]，P =0.03），以及与第24小时较高的NIHSS评分相关（校正β =0.11 [0.02, 0.19]，P =0.01）。未发现IMR与90天改良Rankin量表（mRS）之间存在独立相关性。
四分之一的患者存在IMR，且与早期神经功能预后较差有关。
