对非增强型计算机断层扫描显示核心区较大但缺血性改变较轻的缺血性中风患者进行血栓切除术

IF 6.3 2区医学 Q1 CLINICAL NEUROLOGY

International Journal of Stroke Pub Date : 2024-04-26 DOI:10.1177/17474930241249588

Gabriel Broocks, Helge Kniep, Rosalie McDonough, Matthias Bechstein, Christian Heitkamp, Laurens Winkelmeier, Susan Klapproth, Tobias Djamsched Faizy, Maximilian Schell, Gerhard Schön, Uta Hanning, Susanne Gellißen, André Kemmling, Panagiotis Papanagiotou, Jens Fiehler, Lukas Meyer

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引用次数: 0

摘要

目的：阿尔伯塔省卒中项目早期 CT 评分（ASPECTS）经常用于指导患者选择机械取栓术（MT）。同样，基于计算机断层扫描灌注（CTP）的半椎体成像也可作为指导治疗的神经成像工具。目的：我们提出了两个假设：1）与核心容积为 50 毫升但 ASPECTS≥6 的高 ASPECTS 患者相比，核心容积为 50 毫升但 ASPECTS≥6 的患者血管再通的治疗效果没有差异；2）血管再通与核心高估有关。方法：我们进行了一项观察性研究，分析了经多模态 CT 分流后连续接受 MT 治疗的缺血性卒中患者。功能终点是第90天时的功能独立率，定义为改良Rankin量表（mRS）0-2。成像终点为核心高估，当CTP得出的核心大于随访成像评估的最终梗死体积时，即为核心高估。eTICI（扩展脑梗塞溶栓治疗）量表评估再通情况。结果：在ASPECTS≥6的630名患者中，91名患者（14.4%）的缺血核心较大。1:1 PSM后，与ASPECTS≥6且核心体积<50 ml的患者（+14.9%,95%CI: 5.7-24.1,p=0.002）相比，核心体积大且ASPECTS≥6的患者（+25.8%,95%CI: 16.3-35.4,p<0.001）的再通治疗效果没有差异。再灌注（aOR：3.87，95%CI：1.66-9.00，p=0.002）和较高的核心容积（aOR：1.04，95%CI：1.02-1.05，p<0.001）与核心高估显著相关。再灌注和较高的核心体积与核心高估显著相关，这可能解释了MT对缺血核心较大但非增强CT显示缺血变化较小的患者的治疗效果。

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Thrombectomy in ischemic stroke patients with large core but minor ischemic changes on non-enhanced computed tomography

Purpose:The Alberta Stroke Program Early CT Score (ASPECTS) is regularly used to guide patient selection for mechanical thrombectomy (MT). Similarly, penumbral imaging based on computed tomography perfusion (CTP) may serve as neuroimaging tool to guide treatment. Yet, patients with a large ischemic core on CTP may show only minor ischemic changes resulting in a high ASPECTS.Aim:We hypothesized twofold: 1) the treatment effect of vessel recanalization in patients with core volume >50ml but ASPECTS≥6 is not different compared to high ASPECTS patients with core volume <50ml, and 2) recanalization is associated with core overestimation.Methods:We conducted an observational study analyzing ischemic stroke patients consecutively treated with MT after triage by multimodal-CT. Functional endpoint was the rate of functional independence at day-90 defined as modified Rankin Scale (mRS) 0-2. Imaging endpoint was core overestimation, which was considered when CTP-derived core was larger than final infarct volume assessed on follow-up imaging. Recanalization was evaluated with the eTICI (extended Thrombolysis in Cerebral Infarction) scale. Multivariable logistic regression analysis and prospensity score matching (PSM) were used to assess the association of recanalization (eTICI≥2b) with functional outcome and core overestimation.Results:Of 630 patients with ASPECTS≥6, 91 patients (14.4%) had a large ischemic core. Following 1:1 PSM, the treatment effect of recanalization was not different in patients with large core and ASPECTS≥6 (+25.8%,95%CI: 16.3-35.4,p<0.001) compared to patients with ASPECTS≥6 and core volume <50 ml (+14.9%,95%CI: 5.7-24.1,p=0.002). Recanalization (aOR: 3.87, 95%CI: 1.66-9.00, p=0.002) and higher core volume (aOR: 1.04,95%CI: 1.02-1.05,p<0.001) were significantly associated with core overestimation.Conclusions:In patients with ASPECTS≥6, core volumes did not significantly modify outcomes following recanalization. Reperfusion and higher core volume were significantly associated with core overestimation which may explain the treatment effect of MT for patients with a large ischemic core but minor ischemic changes on non-enhanced CT.

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来源期刊

International Journal of Stroke 医学-外周血管病

CiteScore

13.90

自引率

6.00%

发文量

132

审稿时长

6-12 weeks

期刊介绍： The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.