Endovascular Stroke Treatment Outcomes After Patient Selection Based on Magnetic Resonance Imaging and Clinical Criteria
Endovascular Stroke Treatment Outcomes After Patient Selection Based on Magnetic Resonance Imaging and Clinical Criteria
复制标题
基于磁共振成像和临床标准选择患者后的血管内卒中治疗结局
DOI：
10.1001/jamaneurol.2015.3000
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发表时间：
2016-01-01
期刊：
影响因子：
29
通讯作者：
Gonzalez, R. Gilberto
中科院分区：
文献类型：
--
作者：
Leslie-Mazwi, Thabele M.;Hirsch, Joshua A.;Gonzalez, R. Gilberto
重要性：选择血管内卒中患者的最佳成像方式尚不清楚。目的评价特定磁共振成像（MRI）和临床标准在急性缺血性脑卒中患者血栓切除术选择中的有效性。在这项观察性、单中心、前瞻性队列研究中，我们研究了2012年1月1日至2014年12月31日期间，72例符合机构标准的大脑中动脉或颈内动脉终末闭塞患者，采用计算机断层血管造影，随后采用弥散加权MRI测定核心梗死体积。在此期间，31例类似缺血性卒中患者接受了血管内治疗，未进行MRI，仅归类为计算机断层扫描，并在二次分析中考虑。采用弥漫性加权成像病变体积和临床标准（年龄、美国国立卫生研究院卒中量表评分、发病时间、基线修正兰金量表评分、预期寿命），前瞻性地将患者分为可能受益（LTB）或不确定受益（UTB）。90天mRS评分，良好定义为90天mRS评分为2或更少。结果40例患者前瞻性分类为LTB， 32例为UTB。再灌注（103例患者中71例）和远期分类为LTB（103例患者中40例）与良好的结果相关(P
IMPORTANCE Which imaging modality is optimal to select patients for endovascular stroke treatment remains unclear.OBJECTIVE To evaluate the effectiveness of specific magnetic resonance imaging (MRI) and clinical criteria in the selection of patients with acute ischemic stroke for thrombectomy.DESIGN, SETTING, AND PARTICIPANTS In this observational, single-center, prospective cohort study, we studied 72 patients with middle cerebral artery or terminal internal carotid artery occlusion using computed tomographic angiography, followed by core infarct volume determination by diffusion weighted MRI, who underwent thrombectomy after meeting institutional criteria from January 1, 2012, through December 31, 2014. In this period, 31 patients with similar ischemic strokes underwent endovascular treatment without MRI and are categorized as computed tomography only and considered in a secondary analysis.INTERVENTIONS Patients were prospectively classified as likely to benefit (LTB) or uncertain to benefit (UTB) using diffusion-weighted imaging lesion volume and clinical criteria (age, National Institutes of Health Stroke Scale score, time from onset, baseline modified Rankin Scale [mRS] score, life expectancy).MAIN OUTCOMES AND MEASURES The 90-day mRS score, with favorable defined as a 90-day mRS score of 2 or less.RESULTS Forty patients were prospectively classified as LTB and 32 as UTB. Reperfusion (71 of 103 patients) and prospective categorization as LTB (40 of 103 patients) were associated with favorable outcomes (P