{"title":"结合络和血流动力学特征预测急性缺血性脑卒中机械取栓患者的预后。","authors":"Zhiruo Song, Xiang Fang, Xuerong Jia, Rui Liu, Dong Yang, Anyu Liao, Feiluola Kasaer, Yan Xu, Zhiguo Zhang, Wusheng Zhu, Kangmo Huang, Xinfeng Liu","doi":"10.1136/jnis-2024-022428","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Despite successful recanalization via mechanical thrombectomy (MT), only half of acute ischemic stroke (AIS) patients achieve functional independence. Post-MT hemodynamic features are insufficiently investigated, and the lack of bilateral comparisons limits individual assessment. Therefore, we aimed to explore how individualized hemodynamic features affect functional outcomes using quantitative digital subtraction angiography (Q-DSA).</p><p><strong>Methods: </strong>We screened three prospective databases for anterior circulation AIS participants with successful recanalization via MT. Hemodynamic features, including time to peak (TTP), were measured for four regions of interest (ROIs) on each side with Q-DSA. ROI<sub>C2</sub> served as a reference for correcting TTP values. We defined TTP variation (TTPV), as the degree of difference in TTP between the symptomatic and the healthy sides. A composite indicator, integrating TTPV and collateral status, was developed to reflect comprehensive perfusion capacity. Multivariable logistic regression was employed to investigate the association between TTPV, or the composite indicator, and functional outcomes (90-day modified Rankin Scale <2).</p><p><strong>Result: </strong>Finally, 201 participants (median (interquartile range (IQR) age 68 (57, 75] years, 64.2% males) were enrolled, and 97 (48.3%) patients achieved favourable functional outcomes. TTPV<sub>C2-M1</sub> was significantly related to favorable functional outcome (adjusted OR (aOR) = 0.627; 95% confidence interval (0.407, 0.966); p=0.034). Additionally, the composite indicator of good collaterals and low TTPV<sub>C2-M1</sub> was a powerful predictor for the favorable outcome (aOR=6.693; 95% confidence interval (2.652, 16.896); P<0.001).</p><p><strong>Conclusion: </strong>TTPV<sub>C2-M1</sub> and the composite perfusion indicator showed significant predictive value in prognosis and potentially guided intra-procedure interventions and subsequent management among AIS patients.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5000,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Combined collaterals and hemodynamic features to predict the prognosis in acute ischemic stroke patients undergoing mechanical thrombectomy.\",\"authors\":\"Zhiruo Song, Xiang Fang, Xuerong Jia, Rui Liu, Dong Yang, Anyu Liao, Feiluola Kasaer, Yan Xu, Zhiguo Zhang, Wusheng Zhu, Kangmo Huang, Xinfeng Liu\",\"doi\":\"10.1136/jnis-2024-022428\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Despite successful recanalization via mechanical thrombectomy (MT), only half of acute ischemic stroke (AIS) patients achieve functional independence. Post-MT hemodynamic features are insufficiently investigated, and the lack of bilateral comparisons limits individual assessment. Therefore, we aimed to explore how individualized hemodynamic features affect functional outcomes using quantitative digital subtraction angiography (Q-DSA).</p><p><strong>Methods: </strong>We screened three prospective databases for anterior circulation AIS participants with successful recanalization via MT. Hemodynamic features, including time to peak (TTP), were measured for four regions of interest (ROIs) on each side with Q-DSA. ROI<sub>C2</sub> served as a reference for correcting TTP values. We defined TTP variation (TTPV), as the degree of difference in TTP between the symptomatic and the healthy sides. A composite indicator, integrating TTPV and collateral status, was developed to reflect comprehensive perfusion capacity. Multivariable logistic regression was employed to investigate the association between TTPV, or the composite indicator, and functional outcomes (90-day modified Rankin Scale <2).</p><p><strong>Result: </strong>Finally, 201 participants (median (interquartile range (IQR) age 68 (57, 75] years, 64.2% males) were enrolled, and 97 (48.3%) patients achieved favourable functional outcomes. TTPV<sub>C2-M1</sub> was significantly related to favorable functional outcome (adjusted OR (aOR) = 0.627; 95% confidence interval (0.407, 0.966); p=0.034). Additionally, the composite indicator of good collaterals and low TTPV<sub>C2-M1</sub> was a powerful predictor for the favorable outcome (aOR=6.693; 95% confidence interval (2.652, 16.896); P<0.001).</p><p><strong>Conclusion: </strong>TTPV<sub>C2-M1</sub> and the composite perfusion indicator showed significant predictive value in prognosis and potentially guided intra-procedure interventions and subsequent management among AIS patients.</p>\",\"PeriodicalId\":16411,\"journal\":{\"name\":\"Journal of NeuroInterventional Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":4.5000,\"publicationDate\":\"2025-01-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of NeuroInterventional Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1136/jnis-2024-022428\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"NEUROIMAGING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of NeuroInterventional Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/jnis-2024-022428","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"NEUROIMAGING","Score":null,"Total":0}
Combined collaterals and hemodynamic features to predict the prognosis in acute ischemic stroke patients undergoing mechanical thrombectomy.
Background: Despite successful recanalization via mechanical thrombectomy (MT), only half of acute ischemic stroke (AIS) patients achieve functional independence. Post-MT hemodynamic features are insufficiently investigated, and the lack of bilateral comparisons limits individual assessment. Therefore, we aimed to explore how individualized hemodynamic features affect functional outcomes using quantitative digital subtraction angiography (Q-DSA).
Methods: We screened three prospective databases for anterior circulation AIS participants with successful recanalization via MT. Hemodynamic features, including time to peak (TTP), were measured for four regions of interest (ROIs) on each side with Q-DSA. ROIC2 served as a reference for correcting TTP values. We defined TTP variation (TTPV), as the degree of difference in TTP between the symptomatic and the healthy sides. A composite indicator, integrating TTPV and collateral status, was developed to reflect comprehensive perfusion capacity. Multivariable logistic regression was employed to investigate the association between TTPV, or the composite indicator, and functional outcomes (90-day modified Rankin Scale <2).
Result: Finally, 201 participants (median (interquartile range (IQR) age 68 (57, 75] years, 64.2% males) were enrolled, and 97 (48.3%) patients achieved favourable functional outcomes. TTPVC2-M1 was significantly related to favorable functional outcome (adjusted OR (aOR) = 0.627; 95% confidence interval (0.407, 0.966); p=0.034). Additionally, the composite indicator of good collaterals and low TTPVC2-M1 was a powerful predictor for the favorable outcome (aOR=6.693; 95% confidence interval (2.652, 16.896); P<0.001).
Conclusion: TTPVC2-M1 and the composite perfusion indicator showed significant predictive value in prognosis and potentially guided intra-procedure interventions and subsequent management among AIS patients.
期刊介绍：
The Journal of NeuroInterventional Surgery (JNIS) is a leading peer review journal for scientific research and literature pertaining to the field of neurointerventional surgery. The journal launch follows growing professional interest in neurointerventional techniques for the treatment of a range of neurological and vascular problems including stroke, aneurysms, brain tumors, and spinal compression.The journal is owned by SNIS and is also the official journal of the Interventional Chapter of the Australian and New Zealand Society of Neuroradiology (ANZSNR), the Canadian Interventional Neuro Group, the Hong Kong Neurological Society (HKNS) and the Neuroradiological Society of Taiwan.
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