Ischemic core thresholds change with time to reperfusion: A case control study.
Ischemic core thresholds change with time to reperfusion: A case control study.
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DOI：
10.1002/ana.25109
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发表时间：
2017-12
影响因子：
11.2
通讯作者：
Parsons M
中科院分区：
文献类型：
--
作者：
Bivard A;Kleinig T;Miteff F;Butcher K;Lin L;Levi C;Parsons M
我们的目的是确定血栓切除术后已知完全再灌注的急性缺血性卒中患者是否与完全再灌注溶栓患者具有相同的基线计算机断层扫描灌注（CTP）缺血性核心阈值来预测梗死。从国际脑卒中灌注成像注册表中，接受血栓切除术的患者按年龄、临床严重程度、闭塞位置和基线灌注病变体积与单独静脉注射阿替普酶治疗的患者相匹配。然后对共登记预处理CTP和24小时弥散加权成像（DWI）进行基于像素的分析，以确定缺血核心的最佳CTP阈值。有132例符合条件的取栓患者和132例匹配的对照组单独使用阿替普酶治疗。基线美国国立卫生研究院卒中量表（中位数，15；四分位间距[IQR]， 11-19）、年龄（中位数，65；IQR, 59-80）和静脉治疗时间（中位数，153分钟；IQR, 82-315）匹配良好（均p < 0.05）。尽管使用先前验证的测量方法（相对脑血流量[rCBF]， <30%）的基线CTP缺血核心容量相似，但取栓患者的24小时梗死核心中位数较小，为17.3ml (IQR, 11.3-32.8)，而阿替普酶治疗的对照组为24.3ml （IQR, 16.7-42.2; p = 0.011）。因此，在取栓患者中，定义缺血核心的最佳阈值为rCBF <20%（曲线下面积[AUC]， 0.89; 95% CI, 0.84, 0.94），而在阿替普酶对照组中，最佳缺血核心阈值为rCBF <30% （AUC, 0.83; 95% CI, 0.77, 0.85）。取栓挽救的组织CBF较低，可能是由于早期再灌注所致。对于实现快速再灌注的患者，应考虑采用更严格的rCBF阈值来估计缺血核心。神经网络学报2017；82:995 - 1003
We aimed to identify whether acute ischemic stroke patients with known complete reperfusion after thrombectomy had the same baseline computed tomography perfusion (CTP) ischemic core threshold to predict infarction as thrombolysis patients with complete reperfusion. Patients who underwent thrombectomy were matched by age, clinical severity, occlusion location, and baseline perfusion lesion volume to patients who were treated with intravenous alteplase alone from the International Stroke Perfusion Imaging Registry. A pixel‐based analysis of coregistered pretreatment CTP and 24‐hour diffusion‐weighted imaging (DWI) was then undertaken to define the optimum CTP thresholds for the ischemic core. There were 132 eligible thrombectomy patients and 132 matched controls treated with alteplase alone. Baseline National Institutes of Health Stroke Scale (median, 15; interquartile range [IQR], 11–19), age (median, 65; IQR, 59–80), and time to intravenous treatment (median, 153 minutes; IQR, 82–315) were well matched (all p > 0.05). Despite similar baseline CTP ischemic core volumes using the previously validated measure (relative cerebral blood flow [rCBF], <30%), thrombectomy patients had a smaller median 24‐hour infarct core of 17.3ml (IQR, 11.3–32.8) versus 24.3ml (IQR, 16.7–42.2; p = 0.011) in alteplase‐treated controls. As a result, the optimal threshold to define the ischemic core in thrombectomy patients was rCBF <20% (area under the curve [AUC], 0.89; 95% CI, 0.84, 0.94), whereas in alteplase controls the optimal ischemic core threshold remained rCBF <30% (AUC, 0.83; 95% CI, 0.77, 0.85). Thrombectomy salvaged tissue with lower CBF, likely attributed to earlier reperfusion. For patients who achieve rapid reperfusion, a stricter rCBF threshold to estimate the ischemic core should be considered. Ann Neurol 2017;82:995–1003
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