在中等血管闭塞中实现成功再灌注以获得更好的预后：半暗带挽救与梗死体积缩小。

Successful reperfusion for better outcomes in medium vessel occlusion: Penumbral salvage versus infarct volume reduction.

作者信息

He Guangchen, Yi Tingyu, Deng Jiangshan, Wei Liming, Lu Haitao, Lin Dinglai, Lin Xiaohui, Zhang Yan, Miao Guihua, Liang Da, Chen Wenhuo, Wang Jingye, Zhu Yueqi

机构信息

Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Department of Interventional Radiology, Fengxian Hospital, The Third School of Clinical Medicine, Southern Medical University, Shanghai, China.

出版信息

Eur Stroke J. 2025 Jul 29:23969873251360492. doi: 10.1177/23969873251360492.

DOI:10.1177/23969873251360492

PMID:40726181

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12307323/

Abstract

BACKGROUND

The benefits of endovascular thrombectomy (EVT) over medical treatment for medium vessel occlusion (MeVO) remain uncertain. Understanding how vascular reperfusion leads to favorable outcomes is crucial. This study examines whether penumbra salvage and infarct volume reduction quantify EVT benefits in MeVO patients and assesses their impact on clinical improvement post-reperfusion.

METHODS

We conducted a multicenter, observational study analyzing MeVO patients who underwent thrombectomy and received multimodal CT imaging from January 2020 to June 2024. EVT efficacy was evaluated by measuring follow-up infarct volume (FIV) on CT scans 24-48 h post-procedure and calculating the penumbra salvage index (PSI). PSI is the ratio of salvaged tissue volume (difference between baseline delay time (DT) >3 s volume and FIV) to baseline DT >3 s volume. Mediation analysis assessed PSI and FIV's contributions to successful reperfusion and functional outcomes.

RESULTS

Of 338 patients, 241 (72%) achieved successful reperfusion. Median FIV was 21 mL (IQR 12-32 mL), and median PSI was 0.68 (IQR 0.50-0.82). Successful reperfusion was linked to a 0.10 increase in PSI (95% CI: 0.05-0.15, < 0.001) and a 4.36 mL reduction in FIV (95% CI: 1.31-7.20, = 0.005). Successful reperfusion predicted improved outcomes, with an adjusted odds ratio (aOR) of 1.92 (95% CI: 1.08-3.47, = 0.020) for excellent outcomes (modified Rankin Scale (mRS) score 0-1) and an aOR of 1.70 (95% CI: 1.01-2.89, = 0.024) for functional independence (mRS score 0-2). PSI and FIV accounted for 44% and 16%, respectively, of the effect of reperfusion on excellent outcomes.

CONCLUSIONS

In acute MeVO patients, penumbra salvage significantly mediates the beneficial relationship between reperfusion and excellent clinical outcomes, more so than infarct volume reduction.

摘要

背景

血管内血栓切除术（EVT）对比药物治疗对中血管闭塞（MeVO）的益处仍不确定。了解血管再灌注如何导致良好预后至关重要。本研究探讨半暗带挽救和梗死体积缩小是否能量化EVT对MeVO患者的益处，并评估它们对再灌注后临床改善的影响。

方法

我们进行了一项多中心观察性研究，分析了2020年1月至2024年6月期间接受血栓切除术并接受多模态CT成像的MeVO患者。通过测量术后24 - 48小时CT扫描上的随访梗死体积（FIV）并计算半暗带挽救指数（PSI）来评估EVT疗效。PSI是挽救组织体积（基线延迟时间（DT）>3秒时的体积与FIV之差）与基线DT>3秒时的体积之比。中介分析评估了PSI和FIV对成功再灌注和功能结局的贡献。

结果

338例患者中，241例（72%）实现了成功再灌注。FIV中位数为21 mL（四分位间距12 - 32 mL），PSI中位数为0.68（四分位间距0.50 - 0.82）。成功再灌注与PSI增加0.10（95%置信区间：0.05 - 0.15，<0.001）和FIV减少4.36 mL（95%置信区间：1.31 - 7.20，=0.005）相关。成功再灌注预示着预后改善，良好预后（改良Rankin量表（mRS）评分0 - 1）的调整优势比（aOR）为1.92（95%置信区间：1.08 - 3.47，=0.020），功能独立（mRS评分0 - 2）的aOR为1.70（95%置信区间：1.01 - 2.89，=0.024）。PSI和FIV分别占再灌注对良好预后影响的44%和16%。