缺血核心体积结合相对灌注率在评估急性脑卒中血管再通及预后中的研究

The study of ischemic core volume combined with the relative perfusion ratio in evaluating vascular recanalization and prognosis in acute stroke

目的探讨急性脑卒中血管内机械取栓(endovascular thrombectomy,EVT)治疗前缺血核心体积(ischemic core volume,ICV)结合相对灌注率在评估血管再通及预后中的价值。材料与方法回顾性分析在本院就诊的急性缺血性脑卒中患者病例200例,所有患者均于治疗前24 h内行MRI检查。灌注加权缺血核心体积(perfusion weighting ICV,pw-ICV)为ICV与相对脑血流量(relative cerebral blood flow,rCBF)相乘。血管完全再通采用mTICI分级评估(0~2a:不全再通;2b~3:完全再通)。预后评估采用3个月mRS评分(0~2分:预后良好;3~6分:预后不良)。统计学分析pw-ICV在血管再通及预后中的预测价值。结果与不全血管再通组(n=68)相比,血管完全再通组(n=132)的治疗前ICV(27.31±19.18 vs.54.45±29.87)较小、pw-ICV(103.82±77.46 vs.216.20±88.19)较小,差异有统计学意义(P<0.05)。与预后不良组(n=71)相比,预后良好组(n=129)的入院NIHSS评分(15.71±6.18 vs.18.27±6.37)较低、治疗前ICV(28.42±17.38 vs.53.51±28.79)较小、pw-ICV(113.27±79.61 vs.221.07±87.37)较小、血管再通率(89.15%vs.23.94%)较高,差异有统计学意义(P<0.05)。Logistic多元逻辑回归分析显示pw-ICV(OR 0.930;95%CI:0.854~1.465;P=0.016)为预测急性脑卒中血管再通的独立预测因子。pw-ICV(OR 0.971;95%CI:0.551~1.865;P=0.025)和血管完全再通(OR 5.26;95%CI:1.572~13.179;P=0.037)为预测急性脑卒中预后的独立预测因子。结论急性缺血性脑卒中患者EVT治疗前pw-ICV在血管再通及预后中具有重要意义。

Objective:To investigate the value of ischemic core volume(ICV)combined with the relative perfusion ratio before endovascular thrombectomy(EVT)in evaluating vascular recanalization and outcome in acute stroke.Materials and Methods:A total of 200 acute ischemic stroke patients in our hospital were analyzed retrospectively.All patients underwent MRI examination before therapy within 24 h.Perfusion weighting ICV(pw-ICV)was defined as ICV multiply by relative cerebral blood flow(rCBF).Complete recanalization was assessed by mTICI grading(0-2 a:incomplete recanalization;2 b-3:complete recanalization);the outcome was evaluated by using mRS score at 3 months(0-2 score:good outcome;3-6 score:poor outcome).Statistical analysis was performed to evaluate the value of pw-ICV in predicting vascular recanalization and outcome.Results:Compared with incomplete revascularization group(n=68),the complete revascularization group had a smaller ICV before therapy was(27.31±19.18 vs.54.45±29.87)and smaller pw-ICV(103.82±77.46 vs.216.20±88.19),the difference was statistically significant(P<0.05).Compared with the outcome group(n=129),the good outcome group(n=71)had a lower NIHSS score(15.71±6.18 vs.18.27±6.37),smaller ICV before therapy(28.42±17.38 vs.53.51±28.79)and smaller pw-ICV(113.27±79.61 vs.221.07±87.37)and higher recanalization rate(89.15%vs.23.94%),the difference was statistically significant(P<0.05).Logistic multiple logistic regression analysis showed that pw-ICV(OR 0.930;95%CI:0.854-1.465;P=0.016)was an independent predictor of recanalization in acute stroke;pw-ICV(OR 0.971;95%CI:0.551-1.865;P=0.025)and complete recanalization(OR 5.26;95%CI:1.572-13.179;P=0.037)were independent predictor of the outcome in acute stroke.Conclusions:pw-ICV plays an important role in recanalization and outcome of acute ischemic stroke before EVT therapy.