Relationships Between Imaging Assessments and Outcomes in Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke
Relationships Between Imaging Assessments and Outcomes in Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke
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DOI：
10.1161/strokeaha.115.010710
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发表时间：
2015-10-01
期刊：
影响因子：
8.3
通讯作者：
Saver, Jeffrey L.
中科院分区：
文献类型：
--
作者：
Albers, Gregory W.;Goyal, Mayank;Saver, Jeffrey L.
背景与目的影像学表现可以预测急性脑卒中患者的预后。在以取栓为主要血管内治疗急性缺血性卒中（SWIFT PRIME）研究中，随机分配到静脉注射组织型纤溶酶原激活剂单独或组织型纤溶酶原激活剂加血管内治疗（接龙装置）的患者的影像学表现与临床和影像学结果之间的关系进行了评估。方法：我们评估了影像学评估（基线失配剖面/缺血核心体积和成功再灌注）与影像学结果（27小时梗死体积/生长）和临床结果（90天修正Rankin评分）之间的关系。预测有利临床结果的影像学变量在单变量和多变量模型中进行评估。结果共纳入195例患者。成功的再灌注和梗死体积（27小时评估）是良好临床结果的强大独立预测因子（90天时修改的Rankin量表评分为0-2）。与单独使用组织型纤溶酶原激活剂（对照组）相比，使用Solitaire +组织型纤溶酶原激活剂（干预）组具有更高的再灌注率、更小的梗死生长、更小的梗死体积和更好的临床结果。在干预组中，基线时错配量较大的患者比基线时错配量较小的患者有更好的治疗反应趋势。
Background and Purpose Imaging findings can predict outcomes in patients with acute stroke. Relationships between imaging findings and clinical and imaging outcomes in patients randomized to intravenous tissue-type plasminogen activator-alone versus tissue-type plasminogen activator plus endovascular therapy (Solitaire device) in the Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke (SWIFT PRIME) study were assessed.Methods We evaluated associations between imaging assessments (baseline mismatch profiles/ischemic core volumes and successful reperfusion) with imaging outcomes (27-hour infarct volume/growth) and clinical outcomes (modified Rankin Scale scores at 90 days). Imaging variables that predict favorable clinical outcomes were assessed in both univariate and multivariate models.Results One hundred and ninety-five patients were included. Successful reperfusion and infarct volume (assessed at 27 hours) were powerful independent predictors of favorable clinical outcomes (modified Rankin Scale score of 0-2 at 90 days). Patients with the target mismatch profile at baseline had a higher rate of reperfusion, lesser infarct growth, smaller infarct volumes, and better clinical outcomes in the Solitaire plus tissue-type plasminogen activator (intervention) group than those in the tissue-type plasminogen activator-alone (control) group. Patients with larger mismatch volumes at baseline had a trend toward better treatment response in the intervention group than patients who had smaller (