Tissueno-reflowdespite full recanalization following thrombectomy for anterior circulation stroke with proximal occlusion: A clinical study
Tissueno-reflowdespite full recanalization following thrombectomy for anterior circulation stroke with proximal occlusion: A clinical study
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DOI：
10.1177/0271678x20954929
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发表时间：
2020-09-22
影响因子：
6.3
通讯作者：
Oppenheim, Catherine
中科院分区：
文献类型：
--
作者：
Schiphorst, Adrien ter;Charron, Sylvain;Oppenheim, Catherine
尽管早期血栓切除，但有相当大一部分急性卒中大血管闭塞患者的预后较差。无再流现象，即在完全再通的情况下微血管再灌注受损，可能导致这种“徒劳的再通”。尽管在动物模型中得到了很好的报道，但无复流在人类中的特征仍然很差。从一个大型的前瞻性血栓切除数据库中，我们纳入了所有颅内近端闭塞、完全再通(改良的脑梗塞溶栓治疗评分为2c-3)的患者，以及基线和24小时MRI的可用性，包括动脉自旋标记灌注图。无复流的手术定义为：i)相对于对侧同源区的低灌注率=40%，通过视觉(两名独立调查人员)和自动图像分析进行评估，以及ii)脑梗塞的随访MRI。33名患者符合条件(中位年龄：70岁，NIHSS：18，卒中发病至再通延迟：208分钟)。只有一名患者符合手术标准，这与目视和自动分析一致。这位患者在卒中发作160分钟后再通，功能恢复良好。在我们的队列患者中，因颅内近端闭塞行血栓摘除后完全稳定再通的患者中，与新发脑梗塞相关的严重的同侧影像低灌注率是罕见的。因此，无复流在人类卒中中可能并不常见，也可能不会对无效的再分析有实质性的贡献。
Despite early thrombectomy, a sizeable fraction of acute stroke patients with large vessel occlusion have poor outcome. Theno-reflowphenomenon, i.e. impaired microvascular reperfusion despite complete recanalization, may contribute to such "futile recanalizations". Although well reported in animal models,no-reflowis still poorly characterized in man. From a large prospective thrombectomy database, we included all patients with intracranial proximal occlusion, complete recanalization (modified thrombolysis in cerebral infarction score 2c-3), and availability of both baseline and 24 h follow-up MRI including arterial spin labeling perfusion mapping.No-reflowwas operationally defined as i) hypoperfusion >= 40% relative to contralateral homologous region, assessed with both visual (two independent investigators) and automatic image analysis, and ii) infarction on follow-up MRI. Thirty-three patients were eligible (median age: 70 years, NIHSS: 18, and stroke onset-to-recanalization delay: 208 min). The operational criteria were met in one patient only, consistently with the visual and automatic analyses. This patient recanalized 160 min after stroke onset and had excellent functional outcome. In our cohort of patients with complete and stable recanalization following thrombectomy for intracranial proximal occlusion, severe ipsilateral hypoperfusion on follow-up imaging associated with newly developed infarction was a rare occurrence. Thus,no-reflowmay be infrequent in human stroke and may not substantially contribute to futile recanalizations.