■最近的大型核心试验强调了机械血栓切除术(MT)在大血管闭塞的急性缺血性中风中的有效性。灌注成像阈值可变和Alberta卒中计划不良早期计算机断层扫描评分可靠性强调需要更标准化,MT患者选择的定量缺血措施。我们的目的是确定与急性缺血性卒中-大血管闭塞患者的不良预后最密切相关的计算机断层扫描灌注参数。
■在这项研究中,从2019年7月29日至2023年1月29日,约翰·霍普金斯大学医疗企业内的2个综合卒中中心(约翰霍普金斯医院-东巴尔的摩和Bayview医学校区)的2个综合卒中中心在一个持续维护的数据库中,我们纳入了急性缺血性卒中-大血管闭塞的患者,其缺血核心体积定义为在计算机断层扫描灌注或Alberta卒中计划早期计算机断层扫描评分<6时相对脑血流量<30%且≥50mL.我们使用接收器工作特性来找到诸如脑血容量(CBV)<34%的参数的最佳截止值,38%,42%,相对脑血流量>20%,30%,34%,38%,最大时间>4、6、8和10秒。主要结局为不良结局(90天改良Rankin量表评分4-6)。多变量模型根据年龄进行了调整,性别,糖尿病,基线美国国立卫生研究院卒中量表,静脉溶栓,还有MT。
■我们确定了59例缺血核心大的患者。受试者工作特征曲线分析表明,CBV<42%≥68mL与不利结果(90天改良Rankin量表评分4-6)相关,曲线下面积为0.90(95%CI,0.82-0.99)。在这个CBV阈值下进行二值化,≥68mL组的患者表现出明显更高的相对脑血流量,最大时间>8和10秒的卷,更高的CBV体积,更高的HIR,降低CBV指数。纳入CBV<42%≥68mL的多变量模型在两个队列中都能可靠地预测不良结局(仅MT亚组的曲线下面积为0.87[95%CI,0.75-1.00])。
CBV<42%≥68mL最有效地预测大核心卒中患者的不良结局,在处理急性缺血性卒中-大血管闭塞时,确认其与其他参数如最大时间一起的价值。
UNASSIGNED: Recent large core trials have highlighted the effectiveness of mechanical thrombectomy (MT) in acute ischemic stroke with large vessel occlusion. Variable perfusion-imaging thresholds and poor Alberta Stroke Program Early Computed Tomography Score reliability underline the need for more standardized, quantitative ischemia measures for MT patient selection. We aimed to identify the computed tomography perfusion parameter most strongly associated with poor outcomes in patients with acute ischemic stroke-large vessel occlusion with significant ischemic cores.
UNASSIGNED: In this study from 2 comprehensive stroke centers from 2 comprehensive stroke centers within the Johns Hopkins Medical Enterprise (Johns Hopkins Hospita-East Baltimore and Bayview Medical Campus) from July 29, 2019 to January 29, 2023 in a continuously maintained database, we included patients with acute ischemic stroke-large vessel occlusion with ischemic core volumes defined as relative cerebral blood flow <30% and ≥50 mL on computed tomography perfusion or Alberta Stroke Program Early Computed Tomography Score <6. We used receiver operating characteristics to find the optimal cutoff for parameters like cerebral blood volume (CBV) <34%, 38%, 42%, and relative cerebral blood flow >20%, 30%, 34%, 38%, and time-to-maximum >4, 6, 8, and 10 seconds. The primary outcome was unfavorable outcomes (90-day modified Rankin Scale score 4-6). Multivariable models were adjusted for age, sex, diabetes, baseline National Institutes of Health Stroke Scale, intravenous thrombolysis, and MT.
UNASSIGNED: We identified 59 patients with large ischemic cores. A receiver operating characteristic curve analysis showed that CBV<42% ≥68 mL is associated with unfavorable outcomes (90-day modified Rankin Scale score 4-6) with an area under the curve of 0.90 (95% CI, 0.82-0.99) in the total and MT-only cohorts. Dichotomizing at this CBV threshold, patients in the ≥68 mL group exhibited significantly higher relative cerebral blood flow, time-to-maximum >8 and 10 seconds volumes, higher CBV volumes, higher HIR, and lower CBV index. The multivariable model incorporating CBV<42% ≥68 mL predicted poor outcomes robustly in both cohorts (area under the curve for MT-only subgroup was 0.87 [95% CI, 0.75-1.00]).
UNASSIGNED: CBV<42% ≥68 mL most effectively forecasts poor outcomes in patients with large-core stroke, confirming its value alongside other parameters like time-to-maximum in managing acute ischemic stroke-large vessel occlusion.