Failure of collateral blood flow is associated with infarct growth in ischemic stroke
Failure of collateral blood flow is associated with infarct growth in ischemic stroke
复制标题
DOI：
10.1038/jcbfm.2013.77
复制
发表时间：
2013-08-01
影响因子：
6.3
通讯作者：
Davis, Stephen M.
中科院分区：
文献类型：
--
作者：
Campbell, Bruce C. V.;Christensen, Soren;Davis, Stephen M.
侧支血流的变化维持动脉闭塞远端的大脑活力，可能会影响梗塞的演变，但此前尚未在人类中得到证实。我们将软脑膜侧支血流相关联，在基线和 3 至 5 天时使用新型灌注磁共振成像 (MRI) 处理进行评估，同时评估灌注参数。灌注原始数据在三个连续切片上取平均值，以在减去基线信号后增加软脑膜侧支血管的连续性，类似于数字减影血管造影。在基线和第 3 至 5 天灌注扩散 MRI 之间评估侧支质量、Tmax 灌注不足严重程度和梗塞生长的变化。对 88 名在缺血性中风发作后 3 至 6 小时内成像的患者进行了急性 MRI 分析。基线时较好的侧支血流与较大的灌注-扩散失配（Spearman's Rho 0.51，P < 0.001）和较小的基线扩散病变体积（Rho = 0.70，P < 0.001）相关。在第 3 至 5 天没有再灌注的 30 名患者中，基线和亚急性成像之间的侧支质量恶化与绝对 (P = 0.02) 和相对 (P < 0.001) 梗塞生长密切相关。侧支循环等级的恶化与平均 Tmax 灌注不足严重程度的增加相关（Rho = 0.68，P < 0.001）。 Tmax 低灌注严重程度的恶化也与绝对（P = 0.003）和相对（P = 0.002）梗塞生长显着相关。侧支血流是动态的，衰竭与梗塞生长相关。
Changes in collateral blood flow, which sustains brain viability distal to arterial occlusion, may impact infarct evolution but have not previously been demonstrated in humans. We correlated leptomeningeal collateral flow, assessed using novel perfusion magnetic resonance imaging (MRI) processing at baseline and 3 to 5 days, with simultaneous assessment of perfusion parameters. Perfusion raw data were averaged across three consecutive slices to increase leptomeningeal collateral vessel continuity after subtraction of baseline signal analogous to digital subtraction angiography. Changes in collateral quality, Tmax hypoperfusion severity, and infarct growth were assessed between baseline and days 3 to 5 perfusion-diffusion MRI. Acute MRI was analysed for 88 patients imaged 3 to 6 hours after ischemic stroke onset. Better collateral flow at baseline was associated with larger perfusion-diffusion mismatch (Spearman's Rho 0.51, P < 0.001) and smaller baseline diffusion lesion volume (Rho = 0.70, P < 0.001). In 30 patients without reperfusion at day 3 to 5, deterioration in collateral quality between baseline and subacute imaging was strongly associated with absolute (P = 0.02) and relative (P < 0.001) infarct growth. The deterioration in collateral grade correlated with increased mean Tmax hypoperfusion severity (Rho = 0.68, P < 0.001). Deterioration in Tmax hypoperfusion severity was also significantly associated with absolute (P = 0.003) and relative (P = 0.002) infarct growth. Collateral flow is dynamic and failure is associated with infarct growth.