Abstract：
BACKGROUND: Acute ischaemic stroke (AIS) is caused by significant disturbances in the cerebral bloodflow (CBF) that lead to brain ischaemia and eventually result in irreversible brain tissue damage. The main goal of its treatment is to restore bloodflow to the areas at risk of necrosis. Intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) are the mainstay of current therapy, with the latter being widely employed in selected patients with radiologically proven large vessel occlusion (LVO). Despite convincing evidence of its efficacy, up to half of patients undergoing endovascular treatment (EVT) still do not achieve a beneficial functional outcome; this is mainly due to unfavourable brain tissue sequelae. Therefore, factors associated with known adverse brain changes, such as larger infarct size or haemorrhagic and oedematous complications, should be adequately addressed.
OBJECTIVE: To review the available literature describing AIS brain tissue outcome assessed by computed tomography (CT) and/ or magnetic resonance imaging (MRI) in patients undergoing MT treatment. Additionally, to evaluate the association of post-MT tissue changes with short- and long-term prognosis.
METHODS: We searched the PubMed, Scopus, EMBASE, and Google Scholar databases according to established criteria.
RESULTS: We found a total of 264 articles addressing the most common types of AIS tissue sequelae after EVT (i.e. MT with or without IVT as bridging therapy) by brain CT and MRI. These were: follow-up infarct volume (FIV), cerebral oedema (COD) and haemorrhagic transformation (HT). As the next step, 37 articles evaluating factors associated with defined outcomes were selected. Several non-modifiable factors such as age, comorbidities, pretreatment neurological deficit, and collateral circulation status were found to affect stroke tissue sequelae, to varying degrees. Additionally, some factors including time to treatment initiation, selection of treatment device, and periprocedural systemic blood pressure, the modification of which can potentially reduce the occurrence of an unfavourable tissue outcome, were identified. Some recently revealed biochemical and serological parameters may play a similar role.
CONCLUSIONS: The identification of factors that affect post-MT ischaemic area evolution may result in studies assessing the effects of their modification, and potentially improve clinical outcomes. Modifiable parameters, including periprocedural systemic blood pressure and some biochemical factors, may be of particular importance.
OBJECTIVE: To review the available literature describing AIS brain tissue outcome assessed by computed tomography (CT) and/ or magnetic resonance imaging (MRI) in patients undergoing MT treatment. Additionally, to evaluate the association of post-MT tissue changes with short- and long-term prognosis.
METHODS: We searched the PubMed, Scopus, EMBASE, and Google Scholar databases according to established criteria.
RESULTS: We found a total of 264 articles addressing the most common types of AIS tissue sequelae after EVT (i.e. MT with or without IVT as bridging therapy) by brain CT and MRI. These were: follow-up infarct volume (FIV), cerebral oedema (COD) and haemorrhagic transformation (HT). As the next step, 37 articles evaluating factors associated with defined outcomes were selected. Several non-modifiable factors such as age, comorbidities, pretreatment neurological deficit, and collateral circulation status were found to affect stroke tissue sequelae, to varying degrees. Additionally, some factors including time to treatment initiation, selection of treatment device, and periprocedural systemic blood pressure, the modification of which can potentially reduce the occurrence of an unfavourable tissue outcome, were identified. Some recently revealed biochemical and serological parameters may play a similar role.
CONCLUSIONS: The identification of factors that affect post-MT ischaemic area evolution may result in studies assessing the effects of their modification, and potentially improve clinical outcomes. Modifiable parameters, including periprocedural systemic blood pressure and some biochemical factors, may be of particular importance.
摘要：
背景：急性缺血性卒中（AIS）由脑血流（CBF）的严重紊乱引起，导致脑缺血并最终导致不可逆的脑组织损伤。其治疗的主要目标是恢复血液流向有坏死风险的区域。静脉溶栓(IVT)和机械取栓(MT)是目前治疗的主要手段,后者广泛用于经放射学证实的大血管闭塞（LVO）的选定患者。尽管有令人信服的证据证明其功效，多达一半接受血管内治疗(EVT)的患者仍未获得有益的功能结局;这主要是由于不利的脑组织后遗症.因此,与已知的不良大脑变化相关的因素，如较大的梗死面积或出血和水肿并发症，应该得到充分解决。
目的：回顾现有文献描述了接受MT治疗的患者通过计算机断层扫描（CT）和/或磁共振成像（MRI）评估的AIS脑组织结局。此外,评估MT后组织变化与短期和长期预后的关系。
方法：我们搜索了PubMed，Scopus,EMBASE,和谷歌学者数据库根据既定的标准。
结果：我们共发现264篇文章通过脑部CT和MRI讨论了EVT后最常见的AIS组织后遗症类型（即有或没有IVT作为桥接治疗的MT）。这些是：随访梗死体积（FIV），脑水肿（COD）和出血性转化（HT）。作为下一步,选择了37篇评估与确定结果相关因素的文章。几个不可改变的因素，如年龄，合并症,治疗前神经功能缺损，侧支循环状态被发现影响中风组织后遗症，在不同程度上。此外,一些因素包括开始治疗的时间，治疗装置的选择，和围手术期全身血压，其修改可以潜在地减少不利组织结果的发生，已确定。最近发现的一些生化和血清学参数可能起着类似的作用。
结论：确定影响MT后缺血区演变的因素可能会导致评估其修饰效果的研究，并有可能改善临床结果。可修改的参数，包括围手术期全身血压和一些生化因素，可能是特别重要的。
目的：回顾现有文献描述了接受MT治疗的患者通过计算机断层扫描（CT）和/或磁共振成像（MRI）评估的AIS脑组织结局。此外,评估MT后组织变化与短期和长期预后的关系。
方法：我们搜索了PubMed，Scopus,EMBASE,和谷歌学者数据库根据既定的标准。
结果：我们共发现264篇文章通过脑部CT和MRI讨论了EVT后最常见的AIS组织后遗症类型（即有或没有IVT作为桥接治疗的MT）。这些是：随访梗死体积（FIV），脑水肿（COD）和出血性转化（HT）。作为下一步,选择了37篇评估与确定结果相关因素的文章。几个不可改变的因素，如年龄，合并症,治疗前神经功能缺损，侧支循环状态被发现影响中风组织后遗症，在不同程度上。此外,一些因素包括开始治疗的时间，治疗装置的选择，和围手术期全身血压，其修改可以潜在地减少不利组织结果的发生，已确定。最近发现的一些生化和血清学参数可能起着类似的作用。
结论：确定影响MT后缺血区演变的因素可能会导致评估其修饰效果的研究，并有可能改善临床结果。可修改的参数，包括围手术期全身血压和一些生化因素，可能是特别重要的。
