Ishihara Hideyuki, Oka Fumiaki, Nishimoto Takuma, Yamane Masatoshi, Sugimoto Kazutaka, Sadahiro Hirokazu
Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
Department of Radiology, Yamaguchi University Hospital, Ube, Yamaguchi, Japan.
Acta Neurochir Suppl. 2025;136:129-134. doi: 10.1007/978-3-031-89844-0_16.
The effectiveness of endovascular thrombectomy (EVT) has been proven in patients with large cerebral infarction. However, the size of the ischemic region before treatment is a significant factor in the outcome, and the optimal method for the evaluation of this region is uncertain. The goal of this study was to investigate apparent diffusion coefficient (ADC) values as a basis for an assessment of the ischemic region before treatment.
A retrospective study was performed in 48 consecutive patients who underwent EVT for acute large vessel occlusion (LVO) with Alberta Stroke Program Early Computed Tomography Score (ASPECTS) ≤5 from 2014 to 2022. Associations of clinical characteristics and ADC-related ischemic region volumes with a favorable outcome (modified Rankin Scale (mRS) 0-3 at 90 days) were examined.
The 48 patients had a median age of 78 years and a median NIHSS score of 23 at admission. Occlusion sites were the internal carotid artery (46%), M1 segment (46%), and M2 segment (8%). Specifically, 18 cases (38%) were mRS 0-3 and 30 (62%) mRS 4-6 at 90 days. In receiver operating characteristic (ROC) analysis, an ischemic region defined as a volume with an ADC < 540 (ADC) had the highest area under the curve (AUC) value (AUC = 0.85). Multivariate analysis showed independent associations between onset to reperfusion time (OR 0.991, 95% CI 0.981-1.000, p = 0.013) and ADC (OR 0.887, 95% CI 0.807-0.976, p = 0.001) with mRS 0-3 at 90 days.
Earlier reperfusion and a smaller ischemic region defined by ADC were related to a favorable outcome in patients with acute LVO with a large ischemic region.
血管内血栓切除术（EVT）在大脑大面积梗死患者中的有效性已得到证实。然而，治疗前缺血区域的大小是影响预后的一个重要因素，而评估该区域的最佳方法尚不确定。本研究的目的是探讨表观扩散系数（ADC）值作为治疗前缺血区域评估的依据。
对2014年至2022年期间连续48例接受EVT治疗急性大血管闭塞（LVO）且阿尔伯塔卒中项目早期计算机断层扫描评分（ASPECTS）≤5的患者进行回顾性研究。研究临床特征和与ADC相关的缺血区域体积与良好预后（90天时改良Rankin量表（mRS）评分为0-3）之间的关联。
48例患者的中位年龄为78岁，入院时美国国立卫生研究院卒中量表（NIHSS）中位评分为23分。闭塞部位为颈内动脉（46%）、M1段（46%）和M2段（8%）。具体而言，90天时18例（38%）患者mRS评分为0-3，30例（62%）患者mRS评分为4-6。在受试者工作特征（ROC）分析中，定义为ADC<540（ADC）的缺血区域的曲线下面积（AUC）值最高（AUC=0.85）。多因素分析显示，90天时发病至再灌注时间（OR 0.991，95%CI 0.981-1.000，p=0.013）和ADC（OR 0.887，95%CI 0.807-0.976，p=0.001）与mRS 0-3独立相关。
在具有大面积缺血区域的急性LVO患者中，更早的再灌注和由ADC定义的较小缺血区域与良好预后相关。
