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학술연구/단체지원/교육 등 연구자 활동을 지속하도록 DBpia가 지원하고 있어요.
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연구자들이 자신의 연구와 전문성을 널리 알리고, 새로운 협력의 기회를 만들 수 있는 네트워킹 공간이에요.
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Background and Purpose Patients with acute ischemic stroke, proximal vessel occlusion and a large ischemic core at presentation are commonly not considered for mechanical thrombectomy (MT). We tested the hypothesis that in patients with baseline large infarct cores, identification of remaining penumbral tissue using perfusion imaging would translate to better outcomes after MT. Methods This was a multicenter, retrospective, core lab adjudicated, cohort study of adult patients with proximal vessel occlusion, a large ischemic core volume (diffusion weighted imaging volume ≥70 mL), with pre-treatment magnetic resonance imaging perfusion, treated with MT (2015 to 2018) or medical care alone (controls; before 2015). Primary outcome measure was 3-month favorable outcome (defined as a modified Rankin Scale of 0–3). Core perfusion mismatch ratio (CPMR) was defined as the volume of critically hypo-perfused tissue (Tmax >6 seconds) divided by the core volume. Multivariable logistic regression models were used to determine factors that were independently associated with clinical outcomes. Outputs are displayed as adjusted odds ratio (aOR) and 95% confidence interval (CI). Results A total of 172 patients were included (MT n=130; Control n=42; mean age 69.0±15.4 years; 36% females). Mean core-volume and CPMR were 102.3±36.7 and 1.8±0.7 mL, respectively. As hypothesized, receiving MT was associated with increased probability of favorable outcome and functional independence, as CPMR increased, a difference becoming statistically significant above a mismatch-ratio of 1.72. Similarly, receiving MT was also associated with favorable outcome in the subgroup of 74 patients with CPMR >1.7 (aOR, 8.12;95% CI, 1.24 to 53.11; P=0.028). Overall (prior to stratification by CPMR) 73 (42.4%) patients had a favorable outcome at 3 months, with no difference amongst groups. Conclusions In patients currently deemed ineligible for MT due to large infarct ischemic cores at baseline, CPMR identifies a subgroup strongly benefiting from MT. Prospective studies are warranted.
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참고문헌 (27)
참고문헌 신청
Powers WJ / 2018 / 2018 Guidelines for the early management of patients with acute ischemic stroke : a guideline for healthcare professionals from the American Heart Association/American Stroke Association / Stroke 49:e46~e110
Turc G / 2019 / European Stroke Organisation(ESO)-European Society for Minimally Invasive Neurological Therapy(ESMINT)guidelines on mechanical thrombectomy in acute ischemic stroke / J Neurointerv Surg 11:535~538
Román LS / 2018 / Imaging features and safety and efficacy of endovascular stroke treatment : a meta-analysis of individual patient-level data / Lancet Neurol 17:895~904
Desilles JP / 2017 / Successful reperfusion with mechanical thrombectomy is associated with reduced disability and mortality in patients with pretreatment diffusion-weighted imaging-alberta stroke program early computed tomography score ≤6 / Stroke 48:963~969
Rebello LC / 2017 / Endovascular treatment for patients with acute stroke who have a large ischemic core and large mismatch imaging profile / JAMA Neurol 74:34~40
Turc G / 2019 / European Stroke Organisation(ESO)-European Society for Minimally Invasive Neurological Therapy(ESMINT)guidelines on mechanical thrombectomy in acute ischemic stroke / J Neurointerv Surg 11:535~538
Román LS / 2018 / Imaging features and safety and efficacy of endovascular stroke treatment : a meta-analysis of individual patient-level data / Lancet Neurol 17:895~904
Desilles JP / 2017 / Successful reperfusion with mechanical thrombectomy is associated with reduced disability and mortality in patients with pretreatment diffusion-weighted imaging-alberta stroke program early computed tomography score ≤6 / Stroke 48:963~969
Rebello LC / 2017 / Endovascular treatment for patients with acute stroke who have a large ischemic core and large mismatch imaging profile / JAMA Neurol 74:34~40
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