Objectives

Computed tomography perfusion (CTP) and computed tomography angiography (CTA) have been recommended to select acute ischemic stroke (AIS) patients for endovascular thrombectomy (EVT) but are not widely used for post-treatment evaluation. We aimed to observe abnormalities in CTP and CTA before and after EVT and evaluate post-EVT CTP and CTA as potential tools for improving clinical outcome prediction.

Methods

Patients with AIS who underwent EVT and received CTP and CTA before and after EVT were retrospectively evaluated. The ischemic core was defined as the volume of relative cerebral blood flow <30% and hypoperfusion as the volume of Tmax >6 s. A reduction in hypoperfusion volume >90% between baseline and post-EVT CTP was defined as tissue optimal reperfusion (TOR). The 90-day modified Rankin scale was used to evaluate the clinical outcome.

Results

Eighty-three patients were included. Patients with an absent ischemic core or with TOR after EVT had a higher rate of modified Thrombolysis in Cerebral Ischemia score 2c-3 and recanalization of post-treatment vessel condition based on follow-up CTA. Multivariable logistic regression revealed that the baseline ischemic core volume (OR:0.934, p=0.009), TOR (OR:8.322, p=0.029) and immediate NIHSS score after EVT (OR:0.761, p=0.012) were factors significantly associated with good clinical outcome. Combining baseline ischemic core volume and TOR with immediate NIHSS score after EVT showed greatest performance for good outcome prediction after EVT(AUC=0.921).

Conclusions

The addition of pretreatment and post-treatment CTP information to purely clinical NIHSS scores might help to improve the efficacy for good outcome prediction after EVT.

中文翻译：

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血栓切除后计算机断层扫描灌注评估的进化模式可预测急性缺血性卒中的结果

目标

计算机断层扫描灌注（CTP）和计算机断层扫描血管造影（CTA）已被推荐用于选择急性缺血性卒中（AIS）患者进行血管内血栓切除术（EVT），但并未广泛用于治疗后评估。我们的目的是观察 EVT 前后 CTP 和 CTA 的异常情况，并评估 EVT 后 CTP 和 CTA 作为改善临床结果预测的潜在工具。

方法

对接受 EVT 并在 EVT 前后接受 CTP 和 CTA 的 AIS 患者进行回顾性评估。核心缺血定义为相对脑血流量<30%，低灌注定义为Tmax>6s。基线和 EVT 后 CTP 之间低灌注量减少 > 90% 被定义为组织最佳再灌注(TOR)。采用90天改良Rankin量表评估临床结果。

结果

其中包括八十三名患者。EVT 后无缺血核心或 TOR 的患者在脑缺血评分 2c-3 中改良溶栓治疗以及基于随访 CTA 的治疗后血管状况再通率较高。多变量逻辑回归显示，基线缺血核心体积（OR：0.934， p = 0.009）、TOR（OR：8.322，p = 0.029）和EVT后立即NIHSS评分（OR：0.761，p = 0.012）是与良好的临床效果。将基线缺血核心体积和 TOR 与 EVT 后立即 NIHSS 评分相结合，显示出 EVT 后良好结果预测的最佳性能（AUC=0.921）。

结论

将治疗前和治疗后 CTP 信息添加到纯粹的临床 NIHSS 评分中可能有助于提高 EVT 后良好结果预测的功效。