Role of post-thrombectomy glymphatic flow in futile recanalization in large-vessel occlusion ischemic stroke.

IF 3.6 2区 医学 Q1 CLINICAL NEUROLOGY
Alan J Finkelstein, Matthew T Sipple, Sajal Medha K Akkipeddi, Racquel Whyte, Gurkirat Singh Kohli, Stephen Susa, Rohin Singh, Prasanth Romiyo, Jianhui Zhong, Tarun Bhalla, Thomas Mattingly, Vincent N Nguyen, Maiken Nedergaard, Matthew T Bender, Derrek Schartz
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引用次数: 0

Abstract

Objective: Stroke is a leading cause of global death and disability, with mechanical thrombectomy remaining the optimal treatment approach for large-vessel occlusion (LVO) ischemic stroke. Despite endovascular recanalization, nearly half of patients experience poor functional outcomes, a phenomenon termed "futile recanalization." The cerebral glymphatic system has emerged as a potential, yet underexplored, therapeutic target. The aim of this study was to use glymphatic diffusion tensor analysis on post-thrombectomy MRI to evaluate the association between glymphatic flow, clinical outcomes, and futile recanalization in patients with LVO ischemic stroke.

Methods: In this retrospective study, 133 patients with anterior LVO ischemic stroke and available post-thrombectomy MRI at a single center from 2017 to 2021 were identified. Futile recanalization was defined by a modified Rankin Scale score > 2 at 90 days despite achieving complete or near-complete angiographic recanalization (modified thrombolysis in cerebral infarction grades 2b-3). Diffusion tensor imaging along the perivascular space was used to evaluate glymphatic function in patients with futile recanalization and patients with functional independence at 90 days. Spearman's rank correlation was used to examine associations between the along the perivascular space index and clinical variables. Effect sizes were calculated and reported using Cohen's d.

Results: Fifty-five patients (24 male, mean age 73.9 years) with anterior circulation LVO ischemic stroke and adequate post-thrombectomy MRI were included for analysis. Overall, glymphatic clearance was lower on the infarcted side compared with the contralateral side (p = 0.035). Patients with futile recanalization had lower glymphatic flow compared with those with functional independence at 90 days (p = 0.049). Additionally, glymphatic flow was significantly associated with the presenting National Institutes of Health Stroke Scale score (ρ = -0.46, p = 0.002).

Conclusions: These findings suggest that patients with futile recanalization have comparatively worse glymphatic clearance. Further research is required to clarify the relationship between futile recanalization and the glymphatic system, which could facilitate the development of therapeutic adjuncts.

大血管闭塞缺血性脑卒中取栓后淋巴血流在无效再通中的作用。
目的:脑卒中是全球死亡和残疾的主要原因,机械取栓仍然是大血管闭塞缺血性脑卒中的最佳治疗方法。尽管进行了血管内再通,但近一半患者的功能结果不佳,这种现象被称为“无效再通”。脑淋巴系统已成为一个潜在的,但尚未充分开发的治疗靶点。本研究的目的是利用取栓后MRI的淋巴弥散张量分析来评估LVO缺血性脑卒中患者淋巴血流、临床结果和无效再通之间的关系。方法:在这项回顾性研究中,对2017年至2021年在单一中心进行的133例左左动脉前路缺血性卒中患者和可用的取栓后MRI进行了分析。无效再通的定义是,尽管在90天内实现了完全或接近完全的血管造影再通(改良的脑梗死溶栓分级为2b-3),但改良的Rankin量表评分为bbbb2。应用沿血管周围间隙弥散张量成像评估无效再通患者和功能独立患者90天的淋巴功能。Spearman等级相关用于检查沿血管周围空间指数与临床变量之间的关系。结果:55例前循环左心室缺血性卒中患者(24名男性,平均年龄73.9岁)和足够的取栓后MRI纳入分析。总的来说,与对侧相比,梗死侧的淋巴清除率较低(p = 0.035)。与功能独立患者相比,无效再通患者在90天的淋巴血流较低(p = 0.049)。此外,淋巴流量与美国国立卫生研究院卒中量表评分显著相关(ρ = -0.46, p = 0.002)。结论:这些结果表明,无效再通患者的淋巴清除率相对较差。无用再通与淋巴系统之间的关系需要进一步的研究来阐明,这可能有助于治疗辅助药物的发展。
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来源期刊
Journal of neurosurgery
Journal of neurosurgery 医学-临床神经学
CiteScore
7.20
自引率
7.30%
发文量
1003
审稿时长
1 months
期刊介绍: The Journal of Neurosurgery, Journal of Neurosurgery: Spine, Journal of Neurosurgery: Pediatrics, and Neurosurgical Focus are devoted to the publication of original works relating primarily to neurosurgery, including studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology. The Editors and Editorial Boards encourage submission of clinical and laboratory studies. Other manuscripts accepted for review include technical notes on instruments or equipment that are innovative or useful to clinicians and researchers in the field of neuroscience; papers describing unusual cases; manuscripts on historical persons or events related to neurosurgery; and in Neurosurgical Focus, occasional reviews. Letters to the Editor commenting on articles recently published in the Journal of Neurosurgery, Journal of Neurosurgery: Spine, and Journal of Neurosurgery: Pediatrics are welcome.
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