一项关于显性、共显性和非显性M2闭塞取栓后平面CT蛛网膜下腔高密度的患病率和临床相关性的双中心研究。

IF 2.6 3区医学 Q2 CLINICAL NEUROLOGY

Neuroradiology Pub Date : 2025-08-01 Epub Date: 2025-06-19 DOI:10.1007/s00234-025-03679-x

Mousa Zidan, Bettina Lara Serrallach, Mattia Branca, Felix Bode, Eike Piechowiak, Thomas Meinel, Nils Christian Lehnen, Tomas Dobrocky, Johannes Kaesmacher, Franziska Dorn

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引用次数: 0

摘要

背景：机械取栓术（MT）后，平面探测器CT （FDCT）上的蛛网膜下腔高密度（SH）与不太有利的临床结果相关。我们的目的是进一步阐明MT后SH的患病率和临床意义，特别是在显性、共显性和非显性M2闭塞患者中。方法：对来自两个综合卒中中心的728例患者进行FDCT上SH的检测。主要结果是FDCT上是否存在SH。次要终点是90天时的修正Rankin量表评分（mRS）。采用分组比较和多变量logistic回归分析基线过程特征和临床结果。为消除混杂因素的影响，采用逆概率加权法建立logistic回归模型。结果：共纳入411例患者。FDCT上SH的患病率为171/411(41.6%)，其中共同和非显性M2闭塞（63%）和显性M2闭塞（53.9%）的患病率特别高。SH的发生与不良的功能预后独立相关(90天mRS的调整OR: 1.5；95% CI, 1.1-2.2)和死亡率增加(aOR: 1.7；95% ci, 1.0-2.8)。合并和非显性M2闭塞的患者发生SH的风险增加尤为明显(P < 0.001 OR = 3.78；95% CI, 2.18-6.57)和显性M2闭塞(P < 0.001 OR = 3.07；95% CI, 1.68-5.59)与大血管闭塞相比。较高的设备通过次数，特别是在3 ~ 6次和大于6次之间，对SH的发生有影响P < 0.001 OR = 2.75；95% CI为1.56 ~ 4.84,P = 0.02 OR = 3.45；95% CI为1.17-10.16，相比较少的通过（1-3）。结论：甲状腺增生在MT后常见，尤其是M2闭塞。它们与共同和非显性M2闭塞患者较差的功能结局和较高的器械通过次数相关（bbb3）。

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A bicentric study on the prevalence and clinical relevance of subarachnoid hyperdensities on flat-detector CT after thrombectomy in dominant, co-dominant, and non-dominant M2 occlusions.

Background: Subarachnoid hyperdensities (SH) on flat-detector CT (FDCT) after mechanical thrombectomy (MT) are associated with less favorable clinical outcomes. We aimed to further elucidate the prevalence and clinical significance of SH following MT, especially in patients with dominant, co- and non-dominant M2 occlusions.

Methods: 728 patients from two comprehensive stroke centers were assessed for the presence of SH on FDCT. The primary outcome was the presence of SH on FDCT. The secondary outcome was modified Rankin Scale scores (mRS) at 90 days. Baseline procedural characteristics and clinical outcomes were analyzed using group comparisons and multivariable logistic regression. To remove the effect of confounding factors, a logistic regression model was built using inverse probability weighting.

Results: In total, 411 patients were included. Prevalence of SH on FDCT was 171/411 (41.6 %), with particularly high prevalence in co- and non-dominant M2 occlusions (63%) and dominant M2 occlusions (53.9%). The occurrence of SH was independently associated with poor functional outcomes (adjusted OR for mRS at 90 days: 1.5; 95% CI, 1.1-2.2) and increased mortality (aOR: 1.7; 95% CI, 1.0-2.8). Increased risk of developing SH was particularly evident in patients with co- and non-dominant M2 occlusions (P < 0.001 OR = 3.78; 95% CI, 2.18-6.57) and dominant M2 occlusions (P < 0.001 OR = 3.07; 95% CI, 1.68-5.59) compared to large vessel occlusions. A higher number of device passes, specifically between 3 and 6 and more than 6, show an effect on the occurrence of SH P < 0.001 OR = 2.75; 95% CI, 1.56-4.84 and P = 0.02 OR = 3.45; 95% CI, 1.17-10.16 compared to fewer passes (1-3).

Conclusion: SH are common after MT, especially in M2 occlusions. They are associated with poorer functional outcomes in patients with co- and non-dominant M2 occlusions and higher numbers of device passes (>3).

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来源期刊

Neuroradiology 医学-核医学

CiteScore

5.30

自引率

3.60%

发文量

214

审稿时长

4-8 weeks

期刊介绍： Neuroradiology aims to provide state-of-the-art medical and scientific information in the fields of Neuroradiology, Neurosciences, Neurology, Psychiatry, Neurosurgery, and related medical specialities. Neuroradiology as the official Journal of the European Society of Neuroradiology receives submissions from all parts of the world and publishes peer-reviewed original research, comprehensive reviews, educational papers, opinion papers, and short reports on exceptional clinical observations and new technical developments in the field of Neuroimaging and Neurointervention. The journal has subsections for Diagnostic and Interventional Neuroradiology, Advanced Neuroimaging, Paediatric Neuroradiology, Head-Neck-ENT Radiology, Spine Neuroradiology, and for submissions from Japan. Neuroradiology aims to provide new knowledge about and insights into the function and pathology of the human nervous system that may help to better diagnose and treat nervous system diseases. Neuroradiology is a member of the Committee on Publication Ethics (COPE) and follows the COPE core practices. Neuroradiology prefers articles that are free of bias, self-critical regarding limitations, transparent and clear in describing study participants, methods, and statistics, and short in presenting results. Before peer-review all submissions are automatically checked by iThenticate to assess for potential overlap in prior publication.