Cerebral Edema in Patients With Large Hemispheric Infarct Undergoing Reperfusion Treatment: A HERMES Meta-Analysis.
Cerebral Edema in Patients With Large Hemispheric Infarct Undergoing Reperfusion Treatment: A HERMES Meta-Analysis.
复制标题
接受再灌注治疗的大面积脑梗塞患者的脑水肿：Hermes Meta分析。
DOI：
10.1161/strokeaha.120.033246
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发表时间：
2021-11
期刊：
影响因子：
8.3
通讯作者：
HERMES Collaborators
中科院分区：
文献类型：
--
作者：
Ng FC;Yassi N;Sharma G;Brown SB;Goyal M;Majoie CBLM;Jovin TG;Hill MD;Muir KW;Saver JL;Guillemin F;Demchuk AM;Menon BK;San Roman L;Liebeskind DS;White P;Dippel DWJ;Davalos A;Bracard S;Mitchell PJ;Wald MJ;Davis SM;Sheth KN;Kimberly WT;Campbell BCV;HERMES Collaborators
再灌注到梗死组织是否会加剧脑水肿对出现广泛不可逆损伤的患者具有治疗意义。我们对2010年1月1日至5月31日发表的7项随机对照试验进行了系统回顾和个体患者水平的荟萃分析，比较了前循环缺血性卒中中取栓与药物治疗的差异，研究了血管内取栓和再灌注对基线时有大半球梗死（LHI）影像学证据的患者脑水肿的影响。2017年（multi Endovascular Devices Highly Effective Reperfusion using Multiple Endovascular Devices (HERMES) collaboration）)，我们分析了取栓与再灌注与随访影像上最大中线移位（MLS）之间的关系，作为LHI患者脑水肿占位效果的衡量指标，在治疗前影像学上定义为弥散- mri或ct -灌注缺血核心80-300mL或非对比ct - alberta - stroke - programa -早期ct - score (CT-ASPECTS)≤5。使用Cochrane工具评估偏倚风险。1764例患者中，有177例出现LHI。当调整年龄、NIHSS、血糖和随访时间成像时，取栓和再灌注与功能改善相关（取栓常见优势比[cOR]=2.30[95%CI 1.32,4.00]；再灌注优势比[cOR]= 4.73[95%CI 1.66,13.52]），但与MLS无关（取栓β= - 0.27[95%CI - 1.52,0.98]；再灌注β= - 0.78[95%CI - 3.07,1.50]）。在一项针对核心容积>130mL或CT-ASPECTS≤3 （n=76）患者的探索性分析中，在调整年龄和NIHSS后，取栓与更大的MLS相关（β=2.76[95%CI 0.33,5.20]），但与功能改善无关（or = 1.71[95%CI 0.24,12.08]）。在LHI患者中，取栓和再灌注与MLS无关，但在核心容量非常大（>130ml）的亚组中，取栓与由于占位性缺血性水肿而增加的MLS相关。减轻大面积梗死患者脑水肿介导的继发性损伤可能进一步改善再灌注治疗后的预后。
Whether reperfusion into infarcted tissue exacerbates cerebral edema has treatment implications in patients presenting with extensive irreversible injury. We investigated the effects of endovascular thrombectomy and reperfusion on cerebral edema in patients presenting with radiological evidence of Large Hemispheric Infarction (LHI) at baseline In a systematic review and individual patient-level meta-analysis of seven randomized controlled trials comparing thrombectomy versus medical therapy in anterior circulation ischemic stroke published between Jan 1, 2010 and May 31, 2017 (Highly Effective Reperfusion using Multiple Endovascular Devices (HERMES) collaboration), we analyzed the association between thrombectomy and reperfusion with maximal midline shift (MLS) on follow-up imaging as a measure of the space-occupying effect of cerebral edema in patients with LHI on pre-treatment imaging, defined as diffusion-MRI or CT-perfusion ischemic core 80–300mL or non-contrast CT-Alberta-Stroke-Program-Early-CT-Score (CT-ASPECTS) ≤5. Risk of bias was assessed using the Cochrane tool. Among 1764 patients, 177 presented with LHI. Thrombectomy and reperfusion were associated with functional improvement (Thrombectomy common odds ratio [cOR]=2.30[95%CI 1.32,4.00]; reperfusion cOR=4.73[95%CI 1.66,13.52]) but not MLS (Thrombectomy β=−0.27[95%CI −1.52,0.98]; reperfusion β=−0.78[95%CI −3.07,1.50]) when adjusting for age, NIHSS, glucose, and time-to-follow-up imaging. In an exploratory analysis of patients presenting with core volume>130mL or CT-ASPECTS≤3 (n=76), thrombectomy was associated with greater MLS after adjusting for age and NIHSS (β=2.76[95%CI 0.33,5.20]) but not functional improvement (OR 1.71[95%CI 0.24,12.08]). In patients presenting with LHI, thrombectomy and reperfusion were not associated with MLS, except in the subgroup with very large core volume (>130ml) in whom thrombectomy was associated with increased MLS due to space-occupying ischemic edema. Mitigating cerebral edema-mediated secondary injury in patients with very large infarcts may further improve outcomes after reperfusion therapies.