Extent of FLAIR Hyperintense Vessels May Modify Treatment Effect of Thrombolysis: A Post hoc Analysis of the WAKE-UP Trial.
Extent of FLAIR Hyperintense Vessels May Modify Treatment Effect of Thrombolysis: A Post hoc Analysis of the WAKE-UP Trial.
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DOI：
10.3389/fneur.2020.623881
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发表时间：
2020
影响因子：
3.4
通讯作者：
Galinovic I
中科院分区：
文献类型：
--
作者：
Grosch AS;Kufner A;Boutitie F;Cheng B;Ebinger M;Endres M;Fiebach JB;Fiehler J;Königsberg A;Lemmens R;Muir KW;Nighoghossian N;Pedraza S;Siemonsen CZ;Thijs V;Wouters A;Gerloff C;Thomalla G;Galinovic I
背景和目标：MRI上的液体衰减反转恢复（FLAIR）高信号血管（FHV）是血管闭塞的放射学标志和侧支循环的间接征象。然而，临床相关性尚不确定。我们探讨了FHV的程度是否与结局相关，以及FHV如何改变WAKE-UP随机对照试验中证实单侧血管闭塞患者亚组的溶栓治疗效果。方法：对165例患者进行分析。两名设盲评估者独立评估FHV的存在和程度（定义为可见FHV的切片数量乘以FLAIR切片厚度）。然后将患者分为两组，以区分少数和广泛的FHV（中位数<30或≥30）。结果：85%的患者（n = 140）和95%的大脑中动脉（MCA）闭塞患者（n = 127）在基线时显示FHV。在MCA闭塞伴少量和广泛FHV的患者之间，相对病变生长（p = 0.971）和短期[随访美国国立卫生研究院卒中量表（NIHSS）评分; p = 0.342]或长期功能恢复[卒中后90天改良兰金量表（mRS）<2; p = 0.607]无差异。在线性回归分析中，基线FHV程度（定义为连续变量）与低灌注组织体积高度相关（β = 2.161; 95% CI 0.96-3.36; p = 0.001）。在校正治疗组、卒中严重程度、病变体积、闭塞部位和再通的多变量回归分析中，FHV未改变功能恢复。然而，在FHV较少的患者中，与接受安慰剂的患者相比，重组组织纤溶酶原激活剂（rtPA）患者获得良好功能结局（mRS）的几率增加[比值比（OR）= 5.3; 95%CI 1.2-24.0]，而在广泛FHV患者中未观察到明显获益（OR = 1.1; 95% CI 0.3-3.8），相互作用的p值为0.11。结论：虽然基线时FHV的程度不会改变卒中在病变进展或功能恢复方面的进展，但它可能会改变治疗效果，因此应被视为符合静脉溶栓条件的患者的相关附加信息。临床试验注册：主试验（WAKE-UP）：ClinicalTrials.gov，NCT 01525290;和EudraCT，2011-005906-32。2012年2月2日注册。
Background and Aims: Fluid-attenuated inversion recovery (FLAIR) hyperintense vessels (FHVs) on MRI are a radiological marker of vessel occlusion and indirect sign of collateral circulation. However, the clinical relevance is uncertain. We explored whether the extent of FHVs is associated with outcome and how FHVs modify treatment effect of thrombolysis in a subgroup of patients with confirmed unilateral vessel occlusion from the randomized controlled WAKE-UP trial. Methods: One hundred sixty-five patients were analyzed. Two blinded raters independently assessed the presence and extent of FHVs (defined as the number of slices with visible FHV multiplied by FLAIR slice thickness). Patients were then separated into two groups to distinguish between few and extensive FHVs (dichotomization at the median <30 or ≥30). Results: Here, 85% of all patients (n = 140) and 95% of middle cerebral artery (MCA) occlusion patients (n = 127) showed FHVs at baseline. Between MCA occlusion patients with few and extensive FHVs, no differences were identified in relative lesion growth (p = 0.971) and short-term [follow-up National Institutes of Health Stroke Scale (NIHSS) score; p = 0.342] or long-term functional recovery [modified Rankin Scale (mRS) <2 at 90 days poststroke; p = 0.607]. In linear regression analysis, baseline extent of FHV (defined as a continuous variable) was highly associated with volume of hypoperfused tissue (β = 2.161; 95% CI 0.96–3.36; p = 0.001). In multivariable regression analysis adjusted for treatment group, stroke severity, lesion volume, occlusion site, and recanalization, FHV did not modify functional recovery. However, in patients with few FHVs, the odds for good functional outcome (mRS) were increased in recombinant tissue plasminogen activator (rtPA) patients compared to those who received placebo [odds ratio (OR) = 5.3; 95% CI 1.2–24.0], whereas no apparent benefit was observed in patients with extensive FHVs (OR = 1.1; 95% CI 0.3–3.8), p-value for interaction was 0.11. Conclusion: While the extent of FHVs on baseline did not alter the evolution of stroke in terms of lesion progression or functional recovery, it may modify treatment effect and should therefore be considered relevant additional information in those patients who are eligible for intravenous thrombolysis. Clinical Trial Registration: Main trial (WAKE-UP): ClinicalTrials.gov, NCT01525290; and EudraCT, 2011-005906-32. Registered February 2, 2012.
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影响因子：
8.3
作者：
Cheng B;Ebinger M;Kufner A;Köhrmann M;Wu O;Kang DW;Liebeskind D;Tourdias T;Singer OC;Christensen S;Warach S;Luby M;Fiebach JB;Fiehler J;Gerloff C;Thomalla G;Stroke Imaging Repository (STIR) Investigators
通讯作者：
Stroke Imaging Repository (STIR) Investigators
影响因子：
8.3
作者：
Ebinger, Martin;Kufner, Anna;Fiebach, Jochen B.
通讯作者：
Fiebach, Jochen B.
影响因子：
9.9
作者：
Lee, K. Y.;Latour, L. L.;Warach, S.
通讯作者：
Warach, S.
影响因子：
2.9
作者：
Perez de la Ossa, N.;Hernandez-Perez, M.;Davalos, A.
通讯作者：
Davalos, A.
影响因子：
3.5
作者：
Gawlitza, Matthias;Gragert, Jasmin;Hoffmann, Karl Titus
通讯作者：
Hoffmann, Karl Titus