Absent filling of the superficial middle cerebral vein is associated with reperfusion but not parenchymal hematoma in stroke patients undergoing thrombectomy: an observational study.
Absent filling of the superficial middle cerebral vein is associated with reperfusion but not parenchymal hematoma in stroke patients undergoing thrombectomy: an observational study.
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大脑中浅静脉充盈不足与接受血栓切除术的中风患者的再灌注相关，但与实质血肿无关：一项观察性研究
DOI：
10.21037/atm-20-1154
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发表时间：
2020-11
影响因子：
--
通讯作者：
Wang Z
中科院分区：
文献类型：
--
作者：
Zhang S;Zhang R;Jin B;Shi Z;Li C;Yu Y;Wang Z
背景脑实质血肿(PH)是卒中后再灌注治疗最令人担忧的并发症。大脑中浅静脉(SMCV)在CT灌注(CTP)上的混浊与卒中后功能预后不良有关，而在接受血栓切除术的急性卒中患者中，其与PH的相关性尚未得到证实。方法对2018年5月至2019年5月连续行血栓清除术的急性前大动脉闭塞(LAO)患者进行回顾性研究。CTP-CT血管成像未检出SMCV(SMCV−)定义为缺血侧全静脉期SMCV无对比剂充盈，SMCV+定义为静脉期任一时间点均有SMCV充盈。结果52例患者中有15例(28.8%)在血栓摘除后48小时内发生PH。在单因素和多因素Logistic回归分析中，−与PH均无相关性，但是再通的独立危险因素[改良溶栓治疗脑梗塞评分2b~3，优势比(OR)=0.172，95%可信区间(CI)：0.031~0.960，P=0.045]。再通与PH风险降低相关(OR=0.110，95%CI：0.013~0.913，P=0.041)。然而，在对再通患者的亚组分析中，−组的PH发生率高于SMCV+组(40.0%vs.13.8%，P=0.049)。结论在接受血栓清除术的患者中，SMCV-−不能预测PH，但是再通的危险因素。尽管再灌注是PH的保护因素，但当再灌注成功时，−组发生PH的风险仍高于SMCV+组。
Background Parenchymal hematoma (PH) is the most feared complication of reperfusion therapy after stroke. The opacification of the superficial middle cerebral vein (SMCV) on computed tomography perfusion (CTP) has been associated with poor functional outcomes after stroke, while its association with PH has not been verified for acute stroke patients undergoing thrombectomy. Methods Consecutive patients with acute anterior large artery occlusion (LAO) who received thrombectomy were retrospectively enrolled between May 2018 and May 2019. Absent filing of the SMCV (SMCV−) on CTP-derived CT angiography was defined as no contrast filling of the SMCV across the whole venous phase in the ischemic hemisphere, while SMCV+ was defined as the presence of contrast filling of the SMCV at any time point of the venous phase. Results A total of 52 patients were enrolled in the study, and 15 patients (28.8%) developed a PH within 48 hours after thrombectomy. SMCV− was not associated with PH in both the univariate and multivariate logistic regression analyses (all P>0.05), but was an independent risk factor for reperfusion [modified thrombolysis in cerebral infarction score of 2b-3; odds ratio (OR) =0.172, 95% confidence interval (CI): 0.031–0.960, P=0.045]. Reperfusion was associated with a reduced risk of PH (OR =0.110, 95% CI: 0.013–0.913, P=0.041). However, in a subgroup analysis of patients who had reperfusion, the SMCV− group had a higher rate of PH than the SMCV+ group (40.0% vs. 13.8%, P=0.049). Conclusions In patients who received thrombectomy, SMCV− did not predict PH, but was a risk factor for reperfusion. Although reperfusion was a protective factor for PH, the SMCV− group was still at a higher risk of PH compared with the SMCV+ group when reperfusion was successfully achieved.
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