FVH/DWI不匹配在判断急性前循环大血管闭塞机械取栓术后血管再通率中的作用

The Role of FVH/DWI Mismatch in Predicting the Recanalization Rate after Mechanical Thrombectomy in Acute Anterior Circulation Large Vessel Occlusion

【目的】探讨液体衰减反转恢复序列血管高信号(FVH)/扩散加权成像(DWI)不匹配在急性前循环大血管闭塞机械取栓术后血管再通率中的作用。【方法】127例急性前循环大血管闭塞患者均行磁共振检查,并给予机械取栓术治疗,术后评估其血管再通率及影响因素。【结果】127例患者行机械取栓术后,98例完全血管再通(A组),29例无/部分血管再通(B组),血管再通率为77.17%;A组与B组患者的性别、年龄、合并症、闭塞部位、发病至磁共振检查时间、入院美国国立卫生院卒中量表评分比较,差异无统计学意义(P>0.05);A组患者侧支循环良好占比高于B组,3个月Rankin修订量表评分低于B组(P<0.05);A组患者FVH评分、FVH/DWI不匹配占比高于B组,DWI梗死体积小于B组(P<0.05);经Spearman相关性分析,FVH/DWI不匹配与急性前循环大血管闭塞机械取栓术后血管再通呈正相关(r s=0.415,P=0.005);经Logistic多元回归分析显示,侧支循环情况、3个月Rankin修订量表评分、FVH/DWI不匹配是血管再通的影响因素(P<0.05)。【结论】FVH/DWI不匹配的急性前循环大血管闭塞机械取栓术后血管再通率更高,应引起临床注意。

【Objective】To investigate the relationship of fluid-attenuated inversion recovery vascular hyperintensity(FVH)/diffusion-weighted imaging(DWI)mismatch with the recanalization rate after mechanical thrombectomy in patients with acute anterior circulation large vessel occlusion(LVO).【Methods】A total of 127 patients with acute anterior circulation LVO underwent MRI and mechanical thrombectomy,and their post-procedural recanalization rates were evaluated.【Results】Of the 127 patients,98 achieved complete recanalization(Group A),while 29 had no or partial recanalization(Group B),with an overall recanalization rate of 77.17%.No statistically significant differences were observed between Group A and Group B regarding gender,age,comorbidities,occlusion site,time from onset to MRI,or NIHSS scores on admission(P>0.05).Group A had a higher proportion of good collateral circulation and lower 3-month modified Rankin Scale(mRS)scores compared to Group B(P<0.05).Group A also had higher FVH scores,a greater proportion of FVH/DWI mismatch,and smaller DWI infarct volumes compared to Group B(P<0.05).Spearman correlation analysis showed a positive correlation between FVH/DWI mismatch and recanalization rate after mechanical thrombectomy in acute anterior circulation LVO(r s=0.415,P=0.005).Logistic regression analysis identified collateral circulation,3-month mRS score,and FVH/DWI mismatch as factors associated with recanalization(P<0.05).【Conclusion】Patients with FVH/DWI mismatch have a higher recanalization rate after mechanical thrombectomy for acute anterior circulation large vessel occlusion,which warrants clinical attention.