Computed Tomography Angiography Collateral Profile Is Directly Linked to Early Edema Progression Rate in Acute Ischemic Stroke
Computed Tomography Angiography Collateral Profile Is Directly Linked to Early Edema Progression Rate in Acute Ischemic Stroke
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DOI：
10.1161/strokeaha.119.027062
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发表时间：
2019-12-01
期刊：
影响因子：
8.3
通讯作者：
Hanning, Uta
中科院分区：
文献类型：
--
作者：
Broocks, Gabriel;Kemmling, Andre;Hanning, Uta
背景和目的--在急性缺血性卒中中，侧支循环不良与不良的临床结局相关，并可能预示着血栓切除成功后的无效再通。明显的早期形成脑缺血性水肿可能是侧支状态差和功能预后下降之间的联系，但这种关系尚未被研究。我们假设侧支循环状态与早期病变水摄取有关，作为水肿进展的定量标志。方法：分析176例接受机械血栓摘除术的大脑中动脉卒中患者。入院时CT血管造影采用5分计分系统判定脑侧支循环状态(侧支状态[CS])，良好侧支定义为CS3~4。用早期脑水肿进展率(EPR)量化脑水肿动力学。EPR是根据入院时的定量病变吸水量除以从症状出现到成像的时间得出的。结果：侧支循环良好的患者EPR的中位数为1.4%/小时(四分位数范围，0.5~3.5%)，低于侧支循环不良的患者的EPR中位数5.8%/小时(四分位数范围，2.1~5.9%；P
Background and Purpose-Poor collateral flow is associated with poor clinical outcome in acute ischemic stroke and may indicate futile recanalization after successful thrombectomy. Pronounced early formation of cerebral ischemic edema may be the link between poor collateral status and declined functional outcome, but this relationship has not been investigated yet. We hypothesized that collateral status is associated with early lesion water uptake as quantitative marker for edema progression.Methods-One hundred seventy-six patients with middle cerebral artery stroke who underwent mechanical thrombectomy were analyzed. Status of cerebral collateral circulation (collaterals status [CS]) was derived using an established 5-point scoring system in admission computed tomography angiography, and good collaterals were defined as CS 3 to 4. Ischemic brain edema dynamics were quantified using early edema progression rate (EPR). EPR was derived from quantitative lesion water uptake in admission computed tomography divided by time from symptom onset to imaging. Good clinical outcome was defined as modified Rankin Scale score 0 to 2 after 90 days.Results-The median EPR was 1.4% per hour (interquartile range, 0.5-3.5%) in patients with good collaterals, which was lower than the median EPR in patients with poor collaterals of 5.8% per hour (interquartile range, 2.1-5.9%; P