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

IF 4.5 3区医学 Q1 CLINICAL NEUROLOGY

European Stroke Journal Pub Date : 2025-07-29 DOI:10.1177/23969873251360492

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

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引用次数: 0

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, p < 0.001) and a 4.36 mL reduction in FIV (95% CI: 1.31-7.20, p = 0.005). Successful reperfusion predicted improved outcomes, with an adjusted odds ratio (aOR) of 1.92 (95% CI: 1.08-3.47, p = 0.020) for excellent outcomes (modified Rankin Scale (mRS) score 0-1) and an aOR of 1.70 (95% CI: 1.01-2.89, p = 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.

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成功的再灌注对中血管闭塞的更好结果：半影挽救与梗死体积减少。

背景：对于中度血管闭塞（MeVO），血管内取栓（EVT）优于药物治疗的益处尚不确定。了解血管再灌注如何导致有利的结果是至关重要的。本研究探讨了半暗带挽救和梗死体积减少是否量化了MeVO患者EVT的益处，并评估了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扫描的随访梗死体积（FIV）和计算半暗带挽救指数（PSI）来评估EVT的疗效。PSI是恢复组织体积（基线延迟时间(DT) >3 s体积与FIV之间的差值）与基线DT >3 s体积的比值。中介分析评估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%）获得再灌注成功。中位FIV为21 mL (IQR 12-32 mL)，中位PSI为0.68 （IQR 0.50-0.82）。再灌注成功与PSI升高0.10相关（95% CI: 0.05-0.15, p = 0.005）。再灌注成功预示预后改善，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% CI: 1.08-3.47, p = 0.020)，功能独立性（mRS评分0-2）的调整优势比（aOR）为1.70 （95% CI: 1.01-2.89, p = 0.024）。PSI和FIV分别占再灌注效果的44%和16%。结论：在急性MeVO患者中，半暗带挽救显著介导再灌注与良好临床结果之间的有益关系，其作用大于梗死体积减少。

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.