Clinical and Imaging Parameters Associated With Hyperacute Infarction Growth in Large Vessel Occlusion Stroke
Clinical and Imaging Parameters Associated With Hyperacute Infarction Growth in Large Vessel Occlusion Stroke
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DOI：
10.1161/strokeaha.119.025809
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发表时间：
2019-10-01
期刊：
影响因子：
8.3
通讯作者：
Kunz, Wolfgang G.
中科院分区：
文献类型：
--
作者：
Puhr-Westerheide, Daniel;Tiedt, Steffen;Kunz, Wolfgang G.
背景和目的：大血管闭塞性卒中可导致高度可变的超急性梗死生长。我们的目的是确定与前循环大血管闭塞性卒中患者超急性梗死生长相关的临床和影像学参数。方法：2009年至2017年，722例连续急性脑卒中患者前瞻性地纳入我们的单中心脑卒中登记。我们选择了所有前循环大血管闭塞性卒中的患者，记录了从症状出现到入院时的CT灌注时间（N=178）。采用CT灌注自动阈值测定缺血核体积。超急性梗死的生长被定义为缺血核心体积除以症状出现的时间，假设从症状出现到入院时成像的时间呈线性进展。侧枝评分采用区域轻脑膜侧枝评分（rLMC）。临床数据包括美国国立卫生研究院卒中入院评分和心血管危险因素。进行回归分析以调整混杂因素。结果：中位缺血核体积为34.4 mL，中位超急性梗死生长为0.27 mL/min。在包括年龄、性别、美国国立卫生研究院卒中量表、血块负担评分、糖尿病、吸烟、高胆固醇血症、高血压、阿尔伯塔卒中计划早期CT评分和rLMC评分在内的回归分析中，只有rLMC评分与超急性梗死的生长有显著的独立关联（校正β =-0.35; P15）， 67人与中度相关（rLMC 11-15）， 46人与不良侧支相关（rLMC）
Background and Purpose-Large vessel occlusion stroke leads to highly variable hyperacute infarction growth. Our aim was to identify clinical and imaging parameters associated with hyperacute infarction growth in patients with an large vessel occlusion stroke of the anterior circulation.Methods-Seven hundred twenty-two consecutive patients with acute stroke were prospectively included in our monocentric stroke registry between 2009 and 2017. We selected all patients with a large vessel occlusion stroke of the anterior circulation, documented times from symptom onset, and CT perfusion on admission for our analysis (N=178). Ischemic core volume was determined with CT perfusion using automated thresholds. Hyperacute infarction growth was defined as ischemic core volume divided by times from symptom onset, assuming linear progression during times from symptom onset to imaging on admission. For collateral assessment, the regional leptomeningeal collateral score (rLMC) was used. Clinical data included the National Institutes of Health Stroke Scale score on admission and cardiovascular risk factors. Regression analysis was performed to adjust for confounders.Results-Median ischemic core volume was 34.4 mL, and median hyperacute infarction growth was 0.27 mL/min. In regression analysis including age, sex, National Institutes of Health Stroke Scale, clot burden score, diabetes mellitus, smoking, hypercholesteremia, hypertension, Alberta Stroke Program Early CT Score, and rLMC scores, only the rLMC score had a significant, independent association with hyperacute infarction growth (adjusted beta=-0.35; P15), 67 with intermediate (rLMC 11-15) and 46 with poor collaterals (rLMC