The presence of a ghost infarct core is associated with fast core growth in acute ischemic stroke.

IF 5.8 3区医学 Q1 CLINICAL NEUROLOGY

European Stroke Journal Pub Date : 2024-10-13 DOI:10.1177/23969873241289320

Mikito Saito, Hiroyuki Kawano, Takuya Adachi, Miho Gomyo, Kenichi Yokoyama, Yoshiaki Shiokawa, Teruyuki Hirano

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引用次数: 0

Abstract

Introduction: The overestimation of ischemic core volume by CT perfusion (CTP) is a critical concern in the selection of candidates for reperfusion therapy. This phenomenon is termed a ghost infarct core (GIC). Core growth rate (CGR) is an indicator of ischemic severity. We aimed to elucidate the association between GIC and CGR.

Patients and methods: Consecutive patients with acute ischemic stroke who underwent mechanical thrombectomy in our institute from March 2017 to July 2022 were enrolled. The initial ischemic core volume (IICV) was measured by pretreatment CTP, and the final infarct volume (FIV) was measured by diffusion-weighted imaging. A GIC was defined by IICV minus FIV > 10 ml. The CGR was calculated by dividing the IICV by the time from onset to CTP. Univariable analysis and a multivariable logistic regression model were used to evaluate the association between GIC-positive and CGR.

Results: Of all 91 patients, 21 (23.1%) were GIC-positive. The GIC-positive group had higher CGR (14.2 [2.6-46.7] vs 4.8 [1.6-17.1] ml/h, p = 0.02) and complete recanalization (n = 15 (71.4%) vs 29 (41.4%), p = 0.02) compared to the GIC-negative group. On receiver-operating characteristic curve analysis, the optimal cutoff point of CGR to predict GIC-positive was 22 ml/h (sensitivity, 0.48; specificity, 0.85; AUC, 0.67). Multivariable logistic regression analysis showed that CGR ⩾ 22 ml/h (OR 6.44, 95% CI [1.59-26.10], p = 0.01) and complete recanalization (OR 3.72, 95% CI [1.14-12.08], p = 0.02) were independent predictors of GIC-positive.

Conclusions: A GIC was associated with fast CGR in acute ischemic stroke. Overestimation of the initial ischemic core may be determined by core growth speed.

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在急性缺血性脑卒中中，幽灵梗死核心的存在与核心的快速生长有关。

简介CT 灌注（CTP）会高估缺血核心容积，这是选择再灌注疗法候选者的关键问题。这种现象被称为幽灵梗死核心（GIC）。核心生长率（CGR）是缺血严重程度的指标。我们旨在阐明 GIC 与 CGR 之间的关联：纳入 2017 年 3 月至 2022 年 7 月期间在我院接受机械血栓切除术的急性缺血性卒中连续患者。初始缺血核心容积（IICV）通过治疗前 CTP 测量，最终梗死容积（FIV）通过弥散加权成像测量。GIC 的定义是 IICV 减去 FIV > 10 毫升。CGR 的计算方法是用 IICV 除以从发病到 CTP 的时间。采用单变量分析和多变量逻辑回归模型评估 GIC 阳性与 CGR 之间的关系：在所有 91 名患者中，21 人（23.1%）为 GIC 阳性。与 GIC 阴性组相比，GIC 阳性组的 CGR（14.2 [2.6-46.7] vs 4.8 [1.6-17.1] ml/h，P = 0.02）和完全再通率（n = 15 (71.4%) vs 29 (41.4%)，P = 0.02）更高。根据接收器运行特征曲线分析，预测 GIC 阳性的最佳 CGR 切点为 22 ml/h（灵敏度为 0.48；特异性为 0.85；AUC 为 0.67）。多变量逻辑回归分析显示，CGR ⩾ 22 ml/h（OR 6.44，95% CI [1.59-26.10]，p = 0.01）和完全再通畅（OR 3.72，95% CI [1.14-12.08]，p = 0.02）是 GIC 阳性的独立预测因素：结论：GIC 与急性缺血性卒中的快速 CGR 相关。结论：GIC 与急性缺血性卒中的快速 CGR 相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Stroke Journal Multiple-

CiteScore

7.50

自引率

6.60%

发文量

102

期刊介绍： Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.