Leukoaraiosis and sex predict the hyperacute ischemic core volume.
Leukoaraiosis and sex predict the hyperacute ischemic core volume.
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DOI：
10.1161/strokeaha.112.679084
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发表时间：
2013-01
期刊：
影响因子：
8.3
通讯作者：
Moonis M
中科院分区：
文献类型：
--
作者：
Henninger N;Lin E;Haussen DC;Lehman LL;Takhtani D;Selim M;Moonis M
脑白质疏松症（LA）和男性与脑血管反应性降低有关，这可能对急性中风时的组织活力产生不利影响。因此，我们的目的是阐明 LA 严重程度和性别对颅内大动脉闭塞 (ILAO) 后超急性缺血核心体积范围的影响。我们分析了 87 名接受急性多模态 CT 成像的急性 ILAO 患者的数据。 LA 严重程度通过非造影 CT 上的 van Swieten 量表进行评估。使用平均通过时间（MTT）和超急性脑血容量（CBV）缺陷的自动计算来分析CT灌注（CTP）数据。使用多元线性和逻辑回归分析来确定超急性梗塞体积的独立预测因子。多变量 Logistic 回归分析显示，严重 LA（VSS 3-4；OR 43.22，95%-CI 6.26-298.42，p<0.001）和男性（OR 7.52，95%-CI 1.38-40.86，p=0.020）与超急性 CBV 病变 >25 mL 独立相关。多元线性回归分析证实了严重 LA (p<0.001) 和男性 (p=0.01) 与较大 CBV 病变之间的关联。按 LA 严重程度或性别分层时，绝对或相对 MTT 病变体积没有显着差异。与男性相比，女性的 CBV 病变体积明显较小 (p=0.036)。严重的 LA 和男性与较大的梗塞核心相关，这增加了性别和 LA 改变大脑对急性脑缺血的内在易感性的观点。未来需要更大规模的研究来证实我们的观察结果，即女性的核心体积较小及其意义。
Leukoaraiosis (LA) and male sex have been associated with decreased cerebrovascular reactivity, which potentially adversely affects tissue viability in acute stroke. Therefore, we aimed to elucidate the contribution of LA-severity and sex to the extent of the hyperacute ischemic core volume following intracranial large artery occlusion (ILAO). We analyzed data from 87 patients with acute ILAO who had acute multimodal CT-imaging. LA-severity was assessed using the van Swieten scale on non-contrast CT. CT-perfusion (CTP) data were analyzed using automatic calculation of the mean transit time (MTT) and hyperacute cerebral blood volume (CBV) defects. Multivariate linear and logistic regression analyses were used to identify independent predictors of the hyperacute infarct-volume. Severe LA (VSS 3–4; OR 43.22, 95%-CI 6.26–298.42, p<0.001) and male sex (OR 7.52, 95%-CI 1.38–40.86, p=0.020) were independently associated with a hyperacute CBV-lesion >25 mL on multivariate logistic regression analysis. Multivariate linear regression analysis confirmed the association between severe LA (p<0.001) and male sex (p=0.01) with larger CBV lesions. There was no significant difference in the absolute or relative MTT-lesion volumes when stratified by LA severity or sex. Women had significantly smaller CBV-lesion volumes compared to men (p=0.036). Severe LA and male sex are associated with larger infarct cores, which adds to the notion that sex and LA alter the brain’s intrinsic susceptibility to acute cerebral ischemia. Future, larger studies are needed to confirm our observation that women have smaller core volumes and its significance.