Impact of endovascular recanalization on quantitative lesion water uptake in ischemic anterior circulation strokes
Impact of endovascular recanalization on quantitative lesion water uptake in ischemic anterior circulation strokes
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DOI：
10.1177/0271678x18823601
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发表时间：
2020-02-01
影响因子：
6.3
通讯作者：
Kemmling, Andre
中科院分区：
文献类型：
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作者：
Broocks, Gabriel;Flottmann, Fabian;Kemmling, Andre
评估再灌注对急性卒中缺血性水肿影响的研究描述了相互矛盾的结果。每脑体积的净水摄取量（NWU）是占位性缺血性水肿的一种新的定量成像生物标志物，可以通过计算机断层扫描（CT）进行测量。我们试图利用定量 NWU 来研究血管再通对缺血性脑水肿形成的影响。在这项多中心观察性研究中，连续筛查了前循环大血管闭塞（LVO）的急性缺血性脑卒中患者。比较了血管再通（脑梗塞溶栓 (TICI) 2 b 或 3）与持续血管闭塞（未进行血栓切除术，TICI 0-1）的患者。在多模式入院 CT 和随访 CT (FCT) 中对病变 NWU 进行量化，并将 Delta NWU 计算为差异。在 194 名患者中，150 名患者成功实现血管内再通，44 名患者持续 LVO。在治疗后的 FCT 中，持续性 LVO 患者的平均（标准差）Delta NWU 为 15.8% (5.7)，血管再通患者为 9.8% (5.8) (p < 0.001)。在多变量回归分析中，与 LVO 相比，血管再通与 Delta NWU 降低 6.3% 独立相关（95% 置信区间：3.7-9.0，p < 0.001）。成功的血管再通与显着减少缺血性脑水肿的形成有关。定量 NWU 可用于比较急性中风的治疗效果。
Studies evaluating the effect of reperfusion on ischemic edema in acute stroke described conflicting results. Net water uptake (NWU) per brain volume is a new quantitative imaging biomarker of space-occupying ischemic edema, which can be measured in computed tomography (CT). We sought to investigate the effects of vessel recanalization on the formation of ischemic brain edema using quantitative NWU. In this multicenter observational study, acute ischemic stroke patients with a large vessel occlusion (LVO) in the anterior circulation were consecutively screened. Patients with vessel recanalization (thrombolysis in cerebral infarction (TICI) 2 b or 3) versus persistent vessel occlusion (no thrombectomy, TICI 0-1) were compared. Lesion-NWU was quantified in multimodal admission CT and follow-up CT (FCT), and Delta NWU was calculated as difference. Of 194 included patients, 150 had successful endovascular recanalization and 44 persistent LVO. In FCT after treatment, the mean (standard deviation) Delta NWU was 15.8% (5.7) in patients with persistent LVO and 9.8% (5.8) with vessel recanalization (p < 0.001). In multivariate regression analysis, vessel recanalization was independently associated with a lowered Delta NWU by 6.3% compared to LVO (95% confidence interval: 3.7-9.0, p < 0.001). Successful vessel recanalization was associated with a significantly reduced formation of ischemic brain edema. Quantitative NWU may be used to compare the treatment effects in acute stroke.