基于低灌注强度比值探讨急性脑卒中首次成功再灌注对预后的影响

目的 探讨不同侧支循环的急性卒中患者血管内机械取栓(endovascular thrombectomy,EVT)治疗后首次成功再灌注(first pass reperfusion,FPR)对预后的影响.材料与方法 回顾性纳入急性脑卒中患者180例,所有患者均于入院后行磁共振灌注成像及EVT治疗.应用低灌注强度比值(hy...

To investigate the impact of first pass reperfusion on functional outcome of acute stroke based on hypoperfusion intensity ratio

Objects:To investigate the impact of first pass reperfusion(FPR)on functional outcome of acute stroke with different collateral circulation after endovascular thrombectomy(EVT).Materials and Methods:A total of 180 acute stroke patients in our hospital were enrolled retrospectively.All patients underwent MR perfusion imaging and EVT therapy.Hypoperfusion intensity ratio(HIR)was used to evaluate collateral circulation.Good collateral circulation was defined as HIR<0.4 and poor collateral circulation was defined as HIR≥0.4.FPR was defined as achieving modified Thrombolysis in Cerebral Infarction(mTICI)2 b-3 after a single pass of the device.Statistical methods were performed to analyze the impact of FPR on the outcome in acute stroke with different collateral circulation after EVT therapy.Results:For patients with HIR≥0.4(n=72),compared with non-FPR group(n=30),the mortality rate at 3 months(11.90%vs.33.33%)was lower and good functional outcome at 3 months(59.52%vs.33.33%)was higher in FPR group(n=42).For patients with HIR<0.4(n=108),the mortality rate at 3 months and good functional outcome at 3 months had no significant differences between two group(P>0.05).Logistic regression analysis showed that FPR was an independent predictor of good functional outcome in acute stroke patients with HIR≥0.4(OR=2.281,95%CI:1.419—5.286;P=0.018).While FPR had no significant difference in predicting the good functional outcome in acute stroke patients with HIR<0.4(OR=1.693,95%CI:0.596-4.798;P=0.319).Conclusions:The effect of FPR on functional outcome is highly dependent on collateral circulation.When the collateral circulation is poor(HIR≥0.4),the effect of FPR on functional outcome is more prominent.