血栓切除术后无回流现象的灌注成像定义比较--什么是最佳灌注成像定义?

IF 8.1 1区 医学 Q1 CLINICAL NEUROLOGY Annals of Neurology Pub Date : 2024-09-03 DOI:10.1002/ana.27073
Chloe A. Mutimer MD, Adnan Mujanovic MD, Johannes Kaesmacher MD, Leonid Churilov PhD, Timothy J. Kleinig PhD, Mark W. Parsons PhD, Peter J. Mitchell MMed, Bruce C.V. Campbell PhD, Felix Ng PhD
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引用次数: 0

摘要

尽管血栓切除术很成功,但无回流现象是导致不良预后的一个潜在因素。目前有多种基于影像学的无回流定义,导致报告的发生率差异很大。我们研究了现有影像学定义之间的一致性,并比较了被确定为无回流患者的特征和预后:方法:我们从两项国际随机对照试验(EXTEND-IA TNK part-1和2)和一项多中心前瞻性观察研究中,对脑梗塞溶栓治疗量表 2c 至 3(eTICI2c-3)血管再灌注患者中接受 24 小时灌注成像的无回流的 4 种现有已发表定义进行了外部验证。结果显示:在131名接受24小时灌注成像的患者中,90天后死亡(修改后的Rankin评分[mRS]≥3)为结果变量:结果:在分析的 131 例患者中,不同定义的无回流发生率存在显著差异(0.8%-22.1%;p 15%),CBV 或 CBF 不对称是唯一能改善 BIC 分析模型拟合度的定义(ΔBIC = -8.105),并且在 eTICI3 再灌注患者中,无回流与临床预后之间存在关联:结论:现有的无回流成像定义在发生率和治疗后灌注成像情况方面存在显著差异,这可能是文献报道的无回流发生率不一的原因。包括 eTICI3 再灌注患者在内,CBV 或 CBF 不对称 >15% 的定义对 90 天后的功能预后最具鉴别作用。ann neurol 2024.
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Comparison of Perfusion Imaging Definitions of the No-Reflow Phenomenon after Thrombectomy—What Is the Best Perfusion Imaging Definition?

The no-reflow phenomenon is a potential contributor to poor outcome despite successful thrombectomy. There are multiple proposed imaging-based definitions of no-reflow leading to wide variations in reported prevalence. We investigated the agreement between existing imaging definitions and compared the characteristics and outcomes of patients identified as having no-reflow.

Methods

We performed an external validation of 4 existing published definitions of no-reflow in thrombectomy patients with extended Thrombolysis in Cerebral Infarction scale 2c to 3 (eTICI2c-3) angiographic reperfusion who underwent 24-hour perfusion imaging from 2 international randomized controlled trials (EXTEND-IA TNK part-1 and 2) and a multicenter prospective observational study. Receiver-operating-characteristic and Bayesian-information-criterion (BIC) analyses were performed with the outcome variable being dependent-or-dead at 90-days (modified Rankin Score [mRS] ≥3).

Results

Of 131 patients analyzed, the prevalence of no-reflow significantly varied between definitions (0.8–22.1%; p < 0.001). There was poor agreement between definitions (kappa 5/6 comparisons <0.212). Among patients with no-reflow according to at least 1 definition, there were significant differences between definitions in the intralesional interside differences in cerebral blood flow (CBF) (p = 0.006), cerebral blood volume (CBV) (p < 0.001), and mean-transit-time (MTT) (p = 0.005). No-reflow defined by 3 definitions was associated with mRS ≥3 at 90 days. The definition of >15% CBV or CBF asymmetry was the only definition that improved model fit on BIC analysis (ΔBIC = −8.105) and demonstrated an association between no-reflow and clinical outcome among patients with eTICI3 reperfusion.

Conclusions

Existing imaging definitions of no-reflow varied significantly in prevalence and post-treatment perfusion imaging profile, potentially explaining the variable prevalence of no-reflow reported in literature. The definition of >15% CBV or CBF asymmetry best discriminated for functional outcome at 90 days, including patients with eTICI3 reperfusion. ANN NEUROL 2024;96:1104–1114

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来源期刊
Annals of Neurology
Annals of Neurology 医学-临床神经学
CiteScore
18.00
自引率
1.80%
发文量
270
审稿时长
3-8 weeks
期刊介绍: Annals of Neurology publishes original articles with potential for high impact in understanding the pathogenesis, clinical and laboratory features, diagnosis, treatment, outcomes and science underlying diseases of the human nervous system. Articles should ideally be of broad interest to the academic neurological community rather than solely to subspecialists in a particular field. Studies involving experimental model system, including those in cell and organ cultures and animals, of direct translational relevance to the understanding of neurological disease are also encouraged.
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