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

IF 4.5 3区 医学 Q1 CLINICAL NEUROLOGY
Giorgio Busto, Andrea Morotti, Ilaria Casetta, Francesco Arba, Guido Fanfani, Francesco Impagliazzo, Francesco Loverre, Andrea Ginestroni, Umberto Pensato, Alessandro Padovani, Enrico Fainardi
{"title":"Target mismatch criteria in acute ischemic stroke patients with distal-medium vessel occlusion.","authors":"Giorgio Busto, Andrea Morotti, Ilaria Casetta, Francesco Arba, Guido Fanfani, Francesco Impagliazzo, Francesco Loverre, Andrea Ginestroni, Umberto Pensato, Alessandro Padovani, Enrico Fainardi","doi":"10.1177/23969873251362205","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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, <i>p</i> < 0.001), excellent outcome (modified Rankin scale 0-1 at 3-months, OR = 3.28, 95%CI = 1.30-8.31, <i>p</i> = 0.012) and final infarct volume (<i>B</i> = -35.52, <i>p</i> = 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, <i>p</i> = 0.002).</p><p><strong>Discussion and conclusion: </strong>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.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251362205"},"PeriodicalIF":4.5000,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12343545/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Stroke Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/23969873251362205","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0

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, p < 0.001), excellent outcome (modified Rankin scale 0-1 at 3-months, OR = 3.28, 95%CI = 1.30-8.31, p = 0.012) and final infarct volume (B = -35.52, p = 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, p = 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.

急性缺血性脑卒中中远端血管闭塞患者靶错配标准。
血管内治疗(EVT)对缺血性脑卒中中远端血管闭塞(DMVO)患者的疗效尚不清楚。我们评估了ct -灌注靶错配标准(TMC)是否可以预测M2非或共显性大脑中动脉DMVO患者的功能独立性。材料和方法:本回顾性研究分析了连续接受EVT的M2 DMVO患者,并在发病后24小时内用多模态CT研究方案成像。使用受试者工作特征曲线分析来确定梗死核心体积截止值,以预测功能独立性(3个月时修改的Rankin量表0-2)。该参数随后被视为TMC的一部分,与半影体积小于10 mL和不匹配比大于或等于1.2一起。采用logistic回归检验TMC与功能独立性之间的关系。结果:共纳入115例M2患者。梗死核体积具有良好的功能独立性判别能力(AUC 0.75;95%CI 0.64-0.84),最佳临界值为≤30 mL(敏感性77%,特异性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, p = 0.012)和最终梗死体积(B = -35.52, p = 0.004)独立相关。在纳入相互作用项后,观察到成功再通和TMC对功能独立性的显著治疗效果(OR = 3.82, 95%CI = 1.64-8.89, p = 0.002)。讨论和结论:在接受EVT的M2非或共显性DMVO患者中,TMC确定为核心体积≥30 mL,半暗区体积大于或等于10 mL,不匹配比大于或等于1.2,与更好的功能结果相关。我们的研究结果表明,EVT后的功能独立性与成功的再通没有直接关系,这确实仅在基线成像良好的患者中有效,包括较小的梗死核尺寸,以及存在较小的半暗区体积。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
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.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信