Cerebral Small Vessel Disease and Infarct Growth in Acute Ischemic Stroke Treated with Intravenous Thrombolysis.

IF 3.8 2区 医学 Q1 CLINICAL NEUROLOGY
Francesco Arba, Simone Ferretti, Richard Leigh, Andreia Fara, Steven J Warach, Marie Luby, Kennedy R Lees, Jesse Dawson
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Abstract

We investigated relations between cerebral small vessel disease (cSVD) markers and evolution of the ischemic tissue from ischemic core to final infarct in people with acute ischemic stroke treated with intravenous thrombolysis. Data from the Stroke Imaging Repository (STIR) and Virtual International Stroke Trials Archive (VISTA) were used. Any pre-existing lacunar infarcts and white matter hyperintensities (WMH) were assessed on magnetic resonance (MR) before thrombolytic therapy. Acute ischemic core and final infarct volume were then assessed by two independent radiologists. The relationship among baseline markers of cSVD, acute ischemic core volume, final infarct volume, infarct growth (IG = final infarct - ischemic core), and infarct growth ratio (IGR = final infarct/ischemic core) was then assessed using linear and ordinal regression adjusted for age, sex, onset-to-treatment time, and stroke severity. We included 165 patients, mean (± SD) age 69.5 (± 15.7) years, 74 (45%) males, mean (± SD) ischemic core volume 25.48 (± 42.22) ml, final infarct volume 52.06 (± 72.88) ml, IG 26.58 (± 51.02) ml, IGR 8.23 (± 38.12). Seventy (42%) patients had large vessel occlusion, 20 (12%) acute small subcortical infarct. WMHs were present in 131 (79%) and lacunar infarcts in 61 (37%) patients. Final infarct volumes were 53.8 ml and 45.2 ml (WMHs/no WMHs), p = 0.139, and 24.6 ml and 25.9 ml (lacunar infarcts/no lacunar infarcts), p = 0.842. In linear and ordinal regression analyses, presence of lacunar infarcts was associated with smaller IG (β =  - 0.17; p = 0.024; cOR = 0.52; 95%CI = 0.28-0.96, respectively) and WMHs were associated with smaller IGR (β =  - 0.30; p = 0.004; cOR = 0.27; 95%CI = 0.11-0.69, respectively). In people with acute ischemic stroke treated with intravenous thrombolysis, cSVD features were associated with smaller growth of the acute ischemic area, suggesting less salvageable tissue at time of reperfusion therapy.

Abstract Image

急性缺血性脑卒中静脉溶栓治疗中的脑小血管病变与梗死生长
我们研究了接受静脉溶栓治疗的急性缺血性卒中患者的脑小血管疾病(cSVD)标记物与缺血组织从缺血核心到最终梗死的演变之间的关系。数据来自中风影像资料库(STIR)和虚拟国际中风试验档案(VISTA)。在溶栓治疗前,通过磁共振(MR)评估了是否存在腔隙性梗死和白质增厚(WMH)。然后由两名独立的放射科医生对急性缺血核心和最终梗塞体积进行评估。然后使用线性和序数回归评估 cSVD 基线标记物、急性缺血核心容积、最终梗死容积、梗死生长(IG = 最终梗死 - 缺血核心)和梗死生长比(IGR = 最终梗死/缺血核心)之间的关系,并对年龄、性别、发病到治疗时间和卒中严重程度进行调整。我们纳入了 165 名患者,平均(± SD)年龄 69.5(± 15.7)岁,74(45%)名男性,平均(± SD)缺血核心容积 25.48(± 42.22)毫升,最终梗死容积 52.06(± 72.88)毫升,IG 26.58(± 51.02)毫升,IGR 8.23(± 38.12)。70例(42%)患者为大血管闭塞,20例(12%)为急性小皮层下梗死。131例(79%)患者存在WMH,61例(37%)患者存在腔隙性梗死。最终梗死体积分别为 53.8 毫升和 45.2 毫升(WMHs/无 WMHs),p = 0.139;24.6 毫升和 25.9 毫升(腔隙性梗死/无腔隙性梗死),p = 0.842。在线性和序数回归分析中,存在腔隙性梗死与较小的 IG 相关(β = - 0.17;p = 0.024;cOR = 0.52;95%CI = 0.28-0.96),而 WMHs 与较小的 IGR 相关(β = - 0.30;p = 0.004;cOR = 0.27;95%CI = 0.11-0.69)。在接受静脉溶栓治疗的急性缺血性脑卒中患者中,cSVD特征与急性缺血区域的较小增长相关,这表明再灌注治疗时可挽救的组织较少。
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来源期刊
Translational Stroke Research
Translational Stroke Research CLINICAL NEUROLOGY-NEUROSCIENCES
CiteScore
13.80
自引率
4.30%
发文量
130
审稿时长
6-12 weeks
期刊介绍: Translational Stroke Research covers basic, translational, and clinical studies. The Journal emphasizes novel approaches to help both to understand clinical phenomenon through basic science tools, and to translate basic science discoveries into the development of new strategies for the prevention, assessment, treatment, and enhancement of central nervous system repair after stroke and other forms of neurotrauma. Translational Stroke Research focuses on translational research and is relevant to both basic scientists and physicians, including but not restricted to neuroscientists, vascular biologists, neurologists, neuroimagers, and neurosurgeons.
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