Impact of collateral flow on tissue fate in acute ischaemic stroke
Impact of collateral flow on tissue fate in acute ischaemic stroke
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DOI：
10.1136/jnnp.2007.132100
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发表时间：
2008-06-01
影响因子：
11
通讯作者：
Liebeskind, D. S.
中科院分区：
文献类型：
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作者：
Bang, O. Y.;Saver, J. L.;Liebeskind, D. S.
背景资料：结肠可以维持半暗带再通前，但基线侧支血流对梗死生长的影响血管内therapy.Methods：Concretive患者进行了一系列的扩散和灌注MRI血管内治疗急性脑缺血之前和之后。我们评估了MRI弥散和灌注损伤指数、血管造影侧支循环分级和梗死生长之间的关系。结果：44例患者中，7例（15.9%）侧支循环分级为差，20例（45.5%）为中，17例（38.6%）为良。尽管弥散灌注不匹配体积根据侧支循环分级没有差异，但侧支循环良好的患者比侧支循环不良的患者有更大面积的轻度灌注延迟（p= 0.005）。在32例接受治疗后3-5天MRI的患者中，治疗前侧支循环程度（r=-0.476，p= 0.006）和弥散-灌注不匹配体积（r= 0.371，p= 0.037）与梗死生长相关。最大的梗死生长发生在非再通和不良侧支循环的患者中。多元回归分析显示，预处理侧支等级是独立相关的梗死growth.Conclusion：我们的数据表明，血管造影侧支等级和半影体积相互作用的形状在接受血管内再通治疗的患者组织的命运。这些血管造影和MRI参数提供了有关残余血流量的补充信息，有助于指导急性脑缺血的治疗决策。
Background: Collaterals may sustain penumbra prior to recanalisation yet the influence of baseline collateral flow on infarct growth following endovascular therapy remains unknown.Methods: Consecutive patients underwent serial diffusion and perfusion MRI before and after endovascular therapy for acute cerebral ischaemia. We assessed the relationship between MRI diffusion and perfusion lesion indices, angiographic collateral grade and infarct growth. Tmax perfusion lesion maps were generated and diffusion-perfusion mismatch regions were divided into Tmax >= 4 s (severe delay) and Tmax >= 2 but < 4 s (mild delay).Results: Among 44 patients, collateral grade was poor in 7 (15.9%), intermediate in 20 (45.5%) and good in 17 (38.6%) patients. Although diffusion-perfusion mismatch volume was not different depending on the collateral grade, patients with good collaterals had larger areas of milder perfusion delay than those with poor collaterals (p= 0.005). Among 32 patients who underwent day 3-5 post-treatment MRIs, the degree of pretreatment collateral circulation (r= -0.476, p= 0.006) and volume of diffusion-perfusion mismatch (r= 0.371, p= 0.037) were correlated with infarct growth. Greatest infarct growth occurred in patients with both non-recanalisation and poor collaterals. Multiple regression analysis revealed that pretreatment collateral grade was independently associated with infarct growth.Conclusion: Our data suggest that angiographic collateral grade and penumbral volume interactively shape tissue fate in patients undergoing endovascular recanalisation therapy. These angiographic and MRI parameters provide complementary information about residual blood flow that may help guide treatment decision making in acute cerebral ischaemia.