脑卒中取栓后早期缺血改变的再通状态和时间演变。

IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY European Stroke Journal Pub Date : 2024-06-01 Epub Date: 2023-11-22 DOI:10.1177/23969873231214207
Pekka Virtanen, Liisa Tomppo, Georgios Georgiopoulos, Nina Brandstack, Erno Peltola, Tatu Kokkonen, Kimmo Lappalainen, Antti Korvenoja, Daniel Strbian
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引用次数: 0

摘要

当今的计算机断层扫描(CT)扫描仪具有良好的空间分辨率和信噪比,是检测大脑早期缺血性改变(EIC)的工具。我们根据取栓后血管再通状况评估EIC的时间变化。患者和方法:该队列包括三级转诊医院连续行前循环急性缺血性卒中取栓治疗的患者。所有基线和随访扫描均筛查任何缺血性改变,并使用阿尔伯塔卒中计划早期CT评分(方面)进一步分类。采用广义线性混合模型分析改良脑梗死溶栓(mTICI)再通状态对缺血变化时间演变的影响。结果:我们纳入了614例ICA、M1或M2闭塞患者。基线时的中位ASPECTS评分为9 (IQR 7-10),约24小时时为7(5-8)。mTICI 3级达到207例(33.8%),2B级达到241例(39.3%),2A级达到77例(12.6%),0-1级达到88例(14.3%)。与mTICI 3型患者相比,mTICI 0-1型和2A型患者在时间方面的变化较差(p)。结论:ICA/M1患者皮质区缺血变化和方面的时间演变与再通治疗的成功有关,而与深部脑结构或M2患者无关。在成功再通后,没有任何患者的EIC在任何脑区恢复。
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Recanalization status and temporal evolution of early ischemic changes following stroke thrombectomy.

Introduction: Present-day computer tomography (CT) scanners have excellent spatial resolution and signal-to-noise ratio and are instrumental detecting early ischemic changes (EIC) in brain. We assessed the temporal changes of EIC based on the recanalization status after thrombectomy.

Patients and methods: The cohort comprises consecutive patients with acute ischemic stroke in anterior circulation treated with thrombectomy in tertiary referral hospital. All baseline and follow-up scans were screened for any ischemic changes and further classified using Alberta Stroke Program Early CT Score (ASPECTS). Generalized linear mixed models were used to analyze the impact of recanalization status using modified Thrombolysis in Cerebral Infarction (mTICI) on temporal evolution of ischemic changes.

Results: We included 614 patients with ICA, M1, or M2 occlusions. Median ASPECTS score was 9 (IQR 7-10) at baseline and 7 (5-8) at approximately 24 h. mTICI 3 was achieved in 207 (33.8%), 2B 241 (39.3%), 2A in 77 (12.6%), and 0-1 in 88 (14.3%) patients. Compared to patients with mTICI 3, those with mTICI 0-1 and 2A had less favorable temporal changes of ASPECTS (p < 0.001). Effect of recanalization was noted in the cortical regions of ICA/M1 patients, but not in their deep structures or patients with M2 occlusions. All ischemic changes detected at baseline were also present at all follow-up images, regardless of the recanalization status.

Conclusions: Temporal evolution of the ischemic changes and ASPECTS are related to the success of the recanalization therapy in cortical regions of ICA/M1 patients, but not in their deep brain structures or M2 patients. In none of the patients did EIC revert in any brain region after successful recanalization.

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来源期刊
CiteScore
7.50
自引率
6.60%
发文量
102
期刊介绍: Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.
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