急性缺血性卒中伴中远段血管闭塞患者的靶点不匹配标准

Target mismatch criteria in acute ischemic stroke patients with distal-medium vessel occlusion.

作者信息

Busto Giorgio, Morotti Andrea, Casetta Ilaria, Arba Francesco, Fanfani Guido, Impagliazzo Francesco, Loverre Francesco, Ginestroni Andrea, Pensato Umberto, Padovani Alessandro, Fainardi Enrico

机构信息

Neuroradiology Unit, Department of Radiology, Careggi University Hospital, Florence, Italy.

Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.

出版信息

Eur Stroke J. 2025 Aug 11:23969873251362205. doi: 10.1177/23969873251362205.

DOI:10.1177/23969873251362205

PMID:40790832

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12343545/

Abstract

INTRODUCTION

The efficacy of endovascular treatment (EVT) in ischemic stroke patients with distal-medium vessel occlusion (DMVO) remains unclear. We evaluated whether CT-perfusion target mismatch criteria (TMC) could predict functional independence in patients with M2 non- or codominant middle cerebral artery DMVO.

MATERIALS AND METHODS

This retrospective study analyzed consecutive patients with M2 DMVO receiving EVT and imaged with multimodal CT study protocol within 24 h from onset. A receiver operating characteristic curve analysis was used to identify the infarct core volume cutoff to predict functional independence (modified Rankin Scale 0-2 at 3-months). This parameter was subsequently considered as part of TMC together with penumbra volume ⩾ 10 mL and mismatch ratio ⩾1.2. The association between TMC and functional independence was tested with logistic regression.

RESULTS

A total of 115 patients with M2 were included. Infarct core volume had good discriminative ability for functional independence (AUC 0.75; 95%CI 0.64-0.84) and the best cut-off value was ⩽30 mL (77% sensitivity, 61% specificity, 69% positive predictive value, 70% negative predictive value). TMC were independently associated with functional independence (OR [odds ratio] = 6.50, 95%CI = 2.37-17.77, < 0.001), excellent outcome (modified Rankin scale 0-1 at 3-months, OR = 3.28, 95%CI = 1.30-8.31, = 0.012) and final infarct volume ( = -35.52, = 0.004). After including interaction terms, a significant treatment effect on functional independence was observed between successful recanalization and TMC (OR = 3.82, 95%CI = 1.64-8.89, = 0.002).

DISCUSSION AND CONCLUSION

In patients with M2 non- or codominant DMVO receiving EVT, TMC identified as core volume ⩽30 mL, penumbra volume ⩾ 10 mL, and mismatch ratio ⩾ 1.2, were associated with better functional outcome. Our findings suggest that functional independence after EVT was not directly related to successful recanalization, which is indeed effective only in patients with a favorable baseline imaging profile, including a small infarct core size, and in the presence of small penumbra volumes.

摘要

引言

血管内治疗（EVT）对伴有中远段血管闭塞（DMVO）的缺血性卒中患者的疗效尚不清楚。我们评估了CT灌注目标不匹配标准（TMC）是否能预测大脑中动脉M2段非优势或共干型DMVO患者的功能独立性。

材料与方法

这项回顾性研究分析了连续接受EVT且在发病后24小时内接受多模态CT研究方案成像的M2段DMVO患者。采用受试者工作特征曲线分析来确定梗死核心体积的截断值，以预测功能独立性（3个月时改良Rankin量表评分为0 - 2分）。该参数随后与半暗带体积⩾10 mL和不匹配率⩾1.2一起被视为TMC的一部分。通过逻辑回归检验TMC与功能独立性之间的关联。

结果

共纳入115例M2段患者。梗死核心体积对功能独立性具有良好的判别能力（AUC 0.75；95%CI 0.64 - 0.84），最佳截断值为⩽30 mL（灵敏度77%，特异度61%，阳性预测值69%，阴性预测值70%）。TMC与功能独立性（OR[比值比]=6.50，95%CI = 2.37 - 17.77，<0.001）、良好预后（3个月时改良Rankin量表评分为0 - 1分，OR = 3.28，95%CI = 1.30 - 8.31，=0.012）和最终梗死体积（= -35.52，=0.004）独立相关。纳入交互项后，成功再通与TMC之间对功能独立性存在显著的治疗效果（OR = 3.