ADC Threshold Indicating the Ischemic Region for Predicting Efficacy in Thrombectomy.

Q2 Medicine

Acta neurochirurgica. Supplement Pub Date : 2025-01-01 DOI:10.1007/978-3-031-89844-0_16

Hideyuki Ishihara, Fumiaki Oka, Takuma Nishimoto, Masatoshi Yamane, Kazutaka Sugimoto, Hirokazu Sadahiro

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引用次数: 0

Abstract

Purpose: 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.

Methods: 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.

Results: 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 (ADC₅₄₀) 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 ADC₅₄₀ (OR 0.887, 95% CI 0.807-0.976, p = 0.001) with mRS 0-3 at 90 days.

Conclusions: Earlier reperfusion and a smaller ischemic region defined by ADC₅₄₀ were related to a favorable outcome in patients with acute LVO with a large ischemic region.

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ADC阈值用于预测取栓疗效的缺血区域。

目的：血管内取栓术（EVT）治疗大面积脑梗死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重要因素，该区域的最佳评估方法尚不确定。本研究的目的是研究表观扩散系数（ADC）值作为治疗前评估缺血区域的基础。方法：回顾性研究2014 - 2022年连续48例因急性大血管闭塞（LVO）而行EVT且阿尔伯塔卒中计划早期计算机断层扫描评分(ASPECTS)≤5的患者。研究了临床特征和adc相关缺血区域体积与良好预后（90天时修改的Rankin量表（mRS） 0-3）的关系。结果：48例患者入院时的中位年龄为78岁，中位NIHSS评分为23分。闭塞部位为颈内动脉（46%）、M1段（46%）和M2段（8%）。其中，90天mRS 0-3例18例（38%），mRS 4-6例30例（62%）。在受试者工作特征（ROC）分析中，ADC < 540的体积（ADC540）定义的缺血区域曲线下面积（AUC）值最高（AUC = 0.85）。多因素分析显示，90天mRS 0-3与发病至再灌注时间（OR 0.991, 95% CI 0.981-1.000, p = 0.013）和ADC540 （OR 0.887, 95% CI 0.807-0.976, p = 0.001）之间存在独立相关性。结论：早期再灌注和ADC540定义的较小的缺血区域与大缺血区域的急性LVO患者的良好预后相关。

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

Acta neurochirurgica. Supplement Medicine-Surgery

CiteScore

1.90

自引率

0.00%

发文量

期刊介绍： In addition to the regular journal, "Acta Neurochirurgica" publishes 3-4 supplement volumes per year. These comprise proceedings of international meetings or other material of general neurosurgical interest.