医学
改良兰金量表
四分位间距
内科学
溶栓
冲程(发动机)
优势比
核医学
心脏病学
外科
缺血性中风
心肌梗塞
缺血
机械工程
工程类
作者
Gabriel Broocks,Lukas Meyer,Sarah Elsayed,Rosalie McDonough,Matthias Bechstein,Tobias D. Faizy,Peter Sporns,Gerhard Schön,Jens Minnerup,Helge Kniep,Uta Hanning,Ewgenia Barow,Peter Schramm,Soenke Langner,Jawed Nawabi,Panagiotis Papanagiotou,Max Wintermark,Maarten G. Lansberg,Gregory W. Albers,Jeremy J Heit,Jens Fiehler,André Kemmling
出处
期刊:Neurology
[Ovid Technologies (Wolters Kluwer)]
日期:2023-02-28
卷期号:100 (9)
被引量:8
标识
DOI:10.1212/wnl.0000000000201601
摘要
The effect of mechanical thrombectomy (MT) on functional outcome in patients with ischemic stroke with low ASPECTS is still uncertain. ASPECTS rating is based on the presence of ischemic hypoattenuation relative to normal; however, the degree of hypoattenuation, which directly reflects net uptake of water, is currently not considered an imaging biomarker in stroke triage. We hypothesized that the effect of thrombectomy on functional outcome in low ASPECTS patients depends on early lesion water uptake.For this multicenter observational study, patients with anterior circulation stroke with ASPECTS ≤5 were consecutively analyzed. Net water uptake (NWU) was assessed as a quantitative imaging biomarker in admission CT. The primary end point was the rate of favorable functional outcome defined as modified Rankin Scale score 0-3 at day 90. The effect of recanalization on functional outcome was analyzed according to the degree of NWU within the early infarct lesion.A total of 254 patients were included, of which 148 (58%) underwent MT. The median ASPECTS was 4 (interquartile range [IQR] 3-5), and the median NWU was 11.4% (IQR 8.9%-15.1%). The rate of favorable outcome was 27.6% in patients with low NWU (<11.4%) vs 6.3% in patients with high NWU (≥11.4%; p < 0.0001). In multivariable logistic regression analysis, NWU was an independent predictor of outcome, whereas vessel recanalization (modified thrombolysis in cerebral infarction ≥2b) was only significantly associated with better outcomes if NWU was lower than 12.6%. In inverse-probability weighting analysis, recanalization was associated with 20.7% (p = 0.01) increase in favorable outcome in patients with low NWU compared with 9.1% (p = 0.06) in patients with high NWU.Early NWU was independently associated with clinical outcome and might serve as an indicator of futile MT in low ASPECTS patients. NWU could be tested as a tool to select low ASPECTS patients for MT.The study is registered within the ClinicalTrials.gov Protocol Registration and Results System (NCT04862507).
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