Wang Tao, Yang Yifan, Wang Haibo, Liu Delin, Wang Jie, Luo Jichang, Yang Renjie, Li Tianhua, Gong Haozhi, Sun Xinyi, Derdeyn Colin P, Ma Yan, Jiao Liqun
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China (T.W., Y.Y., D.L., J.W., J.L., R.Y., T.L., H.G., X.S., Y.M., L.J.).
China International Neuroscience Institute (China-INI), Beijing, China (T.W., Y.Y., D.L., J.W., J.L., R.Y., T.L., H.G., X.S., Y.M., L.J.).
Stroke. 2025 Sep;56(9):2579-2587. doi: 10.1161/STROKEAHA.125.051352. Epub 2025 Jun 19.
It is unknown whether computed tomographic perfusion (CTP) parameters predict ischemic stroke in patients with symptomatic chronic carotid or middle cerebral artery occlusion.
A post hoc analysis of medically treated patients enrolled in the CMOSS trial (Carotid or Middle Cerebral Artery Occlusion Surgery Study; URL: https://www.clinicaltrials.gov; Unique identifier: NCT01758614), a randomized controlled trial conducted at 13 centers in China between June 2013 and March 2018. It aimed to compare extracranial-intracranial bypass surgery to medical therapy in patients with symptomatic carotid or middle cerebral artery occlusion and hemodynamic insufficiency. CTP-derived mean transit time and relative cerebral blood flow were collected. The primary outcome was defined as ischemic stroke in the territory of the qualifying artery within 2 years after randomization. The predictive value of CTP for the primary outcome was analyzed by a Cox regression model. Receiver operating characteristic curves were used to calculate optimal cutoff values of CTP parameters.
All 165 per-protocol patients (median age=53.7 years, 81.2% men) treated with medical treatment alone were analyzed. Sixteen (9.7%) patients suffered the primary outcome during the 2-year follow-up. Cutoff values of mean transit time >6.5 seconds (symptomatic side) and relative cerebral blood flow ≤0.5 were associated with recurrent stroke. In multivariate Cox regression, mean transit time (adjusted hazard ratio, 3.50 [95% CI, 1.19-10.30]; =0.02) and relative cerebral blood flow (adjusted hazard ratio, 7.36 [95% CI, 2.27-23.85]; =0.001) were independently associated with the primary outcome.
CTP-based hemodynamic parameters are predictive of recurrent ischemic stroke in symptomatic patients with chronic carotid or middle cerebral artery occlusion. CTP could be used in patient selection for stratified secondary prevention of stroke in future studies.
URL: https://www.clinicaltrials.gov; Unique identifier: NCT01758614.
对于有症状的慢性颈动脉或大脑中动脉闭塞患者，计算机断层扫描灌注（CTP）参数能否预测缺血性卒中尚不清楚。
对纳入CMOSS试验（颈动脉或大脑中动脉闭塞手术研究；网址：https://www.clinicaltrials.gov；唯一标识符：NCT01758614）的接受药物治疗的患者进行事后分析，该试验是2013年6月至2018年3月在中国13个中心进行的一项随机对照试验。其旨在比较有症状的颈动脉或大脑中动脉闭塞及血流动力学不足患者的颅外-颅内搭桥手术与药物治疗。收集CTP得出的平均通过时间和相对脑血流量。主要结局定义为随机分组后2年内符合条件动脉供血区域内的缺血性卒中。通过Cox回归模型分析CTP对主要结局的预测价值。采用受试者工作特征曲线计算CTP参数的最佳截断值。
对仅接受药物治疗的165例符合方案患者（中位年龄=53.7岁，81.2%为男性）进行分析。16例（9.7%）患者在2年随访期间出现主要结局。平均通过时间>6.5秒（症状侧）和相对脑血流量≤0.5的截断值与复发性卒中相关。在多变量Cox回归中，平均通过时间（调整后风险比，3.50[95%CI，1.19 - 10.30]；P = 0.02）和相对脑血流量（调整后风险比，7.36[95%CI，2.27 - 23.85]；P = 0.001）与主要结局独立相关。
基于CTP的血流动力学参数可预测有症状的慢性颈动脉或大脑中动脉闭塞患者的复发性缺血性卒中。在未来研究中，CTP可用于选择患者进行卒中分层二级预防。
