Brain edema growth after thrombectomy is associated with comprehensive collateral blood flow.

IF 4.5 1区医学 Q1 NEUROIMAGING Journal of NeuroInterventional Surgery Pub Date : 2024-11-22 DOI:10.1136/jnis-2023-020921

Tobias D Faizy, Laurens Winkelmeier, Michael Mlynash, Gabriel Broocks, Christian Heitkamp, Christian Thaler, Noel van Horn, Pierre Seners, Helge Kniep, Paul Stracke, Kamil Zelenak, Maarten G Lansberg, Gregory W Albers, Max Wintermark, Jens Fiehler, Jeremy J Heit

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Abstract

Background: We determined whether a comprehensive assessment of cerebral collateral blood flow is associated with ischemic lesion edema growth in patients successfully treated by thrombectomy.

Methods: This was a multicenter retrospective study of ischemic stroke patients who underwent thrombectomy treatment of large vessel occlusions. Collateral status was determined using the cerebral collateral cascade (CCC) model, which comprises three components: arterial collaterals (Tan Scale) and venous outflow profiles (Cortical Vein Opacification Score) on CT angiography, and tissue-level collaterals (hypoperfusion intensity ratio) on CT perfusion. Quantitative ischemic lesion net water uptake (NWU) was used to determine edema growth between admission and follow-up non-contrast head CT (ΔNWU). Three groups were defined: CCC+ (good pial collaterals, tissue-level collaterals, and venous outflow), CCC- (poor pial collaterals, tissue-level collaterals, and venous outflow), and CCCmixed (remainder of patients). Primary outcome was ischemic lesion edema growth (ΔNWU). Multivariable regression models were used to assess the primary and secondary outcomes.

Results: 538 patients were included. 157 patients had CCC+, 274 patients CCCmixed, and 107 patients CCC- profiles. Multivariable regression analysis showed that compared with patients with CCC+ profiles, CCC- (β 1.99, 95% CI 0.68 to 3.30, P=0.003) and CCC mixed (β 1.65, 95% CI 0.75 to 2.56, P<0.001) profiles were associated with greater ischemic lesion edema growth (ΔNWU) after successful thrombectomy treatment. ΔNWU (OR 0.74, 95% CI 0.68 to 0.8, P<0.001) and CCC+ (OR 13.39, 95% CI 4.88 to 36.76, P<0.001) were independently associated with functional independence.

Conclusion: A comprehensive assessment of cerebral collaterals using the CCC model is strongly associated with edema growth and functional independence in acute stroke patients successfully treated by endovascular thrombectomy.

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血栓切除术后脑水肿的增长与综合侧支血流有关。

背景：我们确定了在血栓切除术成功治疗的患者中，对脑侧支血流的综合评估是否与缺血性病变水肿的生长有关。方法：这是一项对接受血栓切除术治疗大血管闭塞的缺血性中风患者的多中心回顾性研究。使用大脑侧支级联（CCC）模型确定侧支状态，该模型包括三个组成部分：CT血管造影术中的动脉侧支（Tan量表）和静脉流出谱（皮质静脉不透明评分），以及CT灌注中的组织水平侧支（低灌注强度比）。定量缺血性病变净摄水量（NWU）用于确定入院和随访非对比度头部CT（ΔNWU）之间的水肿增长。定义了三组：CCC+（软脑膜良络、组织级络和静脉流出）、CCC-（软脑膜差络、组织级别络和静脉外流）和CCCmixed（其余患者）。主要转归为缺血性病变水肿生长（ΔNWU）。多变量回归模型用于评估主要和次要结果。结果：纳入538例患者。157名患者具有CCC+，274名患者具有CCC混合型，107名患者具有CCC-型。多元回归分析显示，与CCC+型患者相比，CCC-（β1.99，95%CI 0.68至3.30，P=0.003）和CCC混合（β1.65，95%CI 0.75至2.56，P结论：在血管内血栓切除术成功治疗的急性卒中患者中，使用CCC模型对脑侧支进行综合评估与水肿生长和功能独立性密切相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of NeuroInterventional Surgery NEUROIMAGING-SURGERY

CiteScore

9.50

自引率

14.60%

发文量

291

审稿时长

4-8 weeks

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.