التفاصيل البيبلوغرافية
| العنوان: |
Characterizing Fast and Slow Progressors in Anterior Circulation Large Vessel Occlusion Strokes. |
| المؤلفون: |
Mohammaden, Mahmoud H, Haussen, Diogo C, Pisani, Leonardo, Al-Bayati, Alhamza R, Bhatt, Nirav R, Jillella, Dinesh V, Bianchi, Nicolas A, Belagaje, Samir R, Frankel, Michael R, Nogueira, Raul G |
| المصدر: |
Interventional Neuroradiology; Aug2023, Vol. 29 Issue 4, p379-385, 7p |
| مصطلحات موضوعية: |
ISCHEMIC stroke, BLOOD pressure, LACUNAR stroke |
| مستخلص: |
Background and Purpose: Infarct growth rate (IGR) in acute ischemic stroke is highly variable. We sought to evaluate impact of symptom-reperfusion time on outcomes in patients undergoing mechanical thrombectomy (MT). Methods: A prospectively maintained database from January,2012-August,2020 was reviewed. All patients with isolated MCA-M1 occlusion who achieved complete reperfusion(mTICI2C-3), had a witnessed symptom onset and follow-up MRI were included. IGR was calculated as final infarct volume (FIV)(ml)/symptom onset to reperfusion time(hours) and was dichotomized according to the median value into slow-(SP) versus fast-progressors (FP). The primary analysis aimed to evaluate the impact of symptom-reperfusion time on 90-day mRS in SP and FP. Secondary analysis was performed to identify predictors of IGR. Results: A total of 137 patients were eligible for analysis. Mean age was 63 ± 15.4 years and median IGR was 5.13ml/hour. SP(n = 69) had higher median ASPECTS, lower median rCBF<30% lesion volume, higher proportion of favorable collaterals and hypoperfusion intensity ratio (HIR)<0.4, higher minimal mean arterial blood pressure before reperfusion, and lower rates of general anesthesia compared to FP(n = 68). Symptom-reperfusion time was comparable between both groups. SP had higher rates of 90-day mRS0-2(71.9%vs.38.9%,aOR;7.226,95%CI[2.431–21.482],p < 0.001) and lower median FIV. Symptom-reperfusion time was associated with 90-day mRS0-2 in FP (aOR;0.541,95%CI[0.309–0.946],p = 0.03) but not in SP (aOR;0.874,95%CI[0.742–1.056],p = 0.16). On multivariable analysis, high ASPECTS and favorable collaterals in the NCCT/CTA model, and low rCBF<30% and HIR<0.4 in the CTP model were independent predictors of SP. Conclusions: The impact of symptom-reperfusion time on outcomes significantly varies across slow-versus fast-progressors. ASPECTS, collateral score, rCBF<30%, and HIR define stroke progression profile. [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
Complementary Index |
