Microvascular reperfusion during endovascular therapy: the balance of supply and demand.
Microvascular reperfusion during endovascular therapy: the balance of supply and demand.
复制标题
血管内治疗期间的微血管再灌注：供需平衡。
DOI：
10.1136/jnis-2023-020834
复制
发表时间：
2023
影响因子：
4.8
通讯作者：
Hu
中科院分区：
文献类型：
--
作者：
Favilla,ChristopherG;Forti,RodrigoM;Carter,Sarah;Kofke,WAndrew;Kasner,ScottE;Baker,WesleyB;Yodh,ArjunG;Messé,StevenR;Cummings,Stephanie;Kung,DavidK;Burkhardt,JanKarl;Choudhri,OmarA;Pukenas,Bryan;Srinivasan,VisishM;Hu
背景血管内治疗（EVT）彻底改变了急性卒中的治疗，但大血管再通并不总是导致组织水平的再灌注。 EVT 期间不常规监测脑血流量 (CBF)。我们的目的是利用漫相关光谱 (DCS) 这种新型经颅光学成像技术来评估微血管 CBF 与 EVT 后结果之间的关系。方法通过 DCS 对 40 名接受 EVT 的患者进行额叶 CBF 监测。基线 CBF 缺陷计算为 EVT 前 CT 灌注时 CBF 损伤的百分比。微血管再灌注计算为再通时 DCS 衍生的 CBF 增加的百分比。再灌注的充分性由持续的 CBF 不足定义，计算公式为：基线 CBF 不足 – 微血管再灌注。良好的功能结果定义为 90 天改良 Rankin 量表评分≤2。结果 40 名患者中有 36 名成功实现再通，其中微血管再灌注本身与梗塞体积或功能结果无关。然而，功能结果良好的患者的持续CBF缺陷（中位数1%（IQR -11%–16%））比功能结果差的患者（中位数28%（IQR 2–50%））更小（p=0.02）。较小的持续 CBF 不足也与较小的梗塞体积相关 (p=0.004)。多变量模型证实，持续的 CBF 缺陷与梗塞体积和功能结果独立相关。结论：单独增加 CBF 并不能预测 EVT 后的结果，但当微血管再灌注与基线 CBF 缺陷密切匹配时，患者会获得良好的临床和影像学结果。通过识别再灌注不足，床边 CBF 监测可能为个性化 EVT 后护理提供机会，以优化 CBF。
BackgroundEndovascular therapy (EVT) has revolutionized the treatment of acute stroke, but large vessel recanalization does not always result in tissue-level reperfusion. Cerebral blood flow (CBF) is not routinely monitored during EVT. We aimed to leverage diffuse correlation spectroscopy (DCS), a novel transcranial optical imaging technique, to assess the relationship between microvascular CBF and post-EVT outcomes.MethodsFrontal lobe CBF was monitored by DCS in 40 patients undergoing EVT. Baseline CBF deficit was calculated as the percentage of CBF impairment on pre-EVT CT perfusion. Microvascular reperfusion was calculated as the percentage increase in DCS-derived CBF that occurred with recanalization. The adequacy of reperfusion was defined by persistent CBF deficit, calculated as: baseline CBF deficit − microvascular reperfusion. A good functional outcome was defined as 90-day modified Rankin Scale score ≤2.ResultsThirty-six of 40 patients achieved successful recanalization, in whom microvascular reperfusion in itself was not associated with infarct volume or functional outcome. However, patients with good functional outcomes had a smaller persistent CBF deficit (median 1% (IQR −11%–16%)) than patients with poor outcomes (median 28% (IQR 2–50%)) (p=0.02). Smaller persistent CBF deficit was also associated with smaller infarct volume (p=0.004). Multivariate models confirmed that persistent CBF deficit was independently associated with infarct volume and functional outcome.ConclusionsCBF augmentation alone does not predict post-EVT outcomes, but when microvascular reperfusion closely matches the baseline CBF deficit, patients experience favorable clinical and radiographic outcomes. By recognizing inadequate reperfusion, bedside CBF monitoring may provide opportunities to personalize post-EVT care aimed at CBF optimization.