探讨不同时间窗的急性缺血性脑卒中机械取栓术后预后的差异  

To explore the outcome differences in acute ischemic stroke with different time windows after mechanical thrombectomy

作　　者：王薇[1] 赵静 彭明洋 谢光辉[1] 殷信道[1] 张艳 WANG Wei;ZHAO Jing;PENG Mingyang;XIE Guanghui;YIN Xindao;ZHANG Yan(Department of Radiology,Nanjing First Hospital,Nanjing Medical University,Nanjing 21006,China;Department of Radiology,Eastern Theater General Hospital,QinHuai District Medical Area,Nanjing 21002,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)医学影像科,南京210006 [2]东部战区总医院秦淮医疗区医学影像科,南京210002

出　　处：《磁共振成像》2021年第3期39-43,共5页Chinese Journal of Magnetic Resonance Imaging

基　　金：江苏省科技发展计划项目(编号:BE2017614);江苏省自然科学基金(编号:BK20201118)。

摘　　要：目的旨在探讨在同样存在扩散加权成像(diffusion-weighted imaging,DWI)-灌注加权成像(perfusion-weighted imaging,PWI)不匹配的前提下,不同时间窗的急性缺血性卒中患者行机械取栓术后预后的差异。材料与方法回顾性分析我院接受机械取栓治疗的急性脑卒中患者200例。所有患者发病时间均为24 h内,且均于治疗前及治疗后接受MRI检查。血管再通程度采用mTICI分级评估。收集所有患者的DWI体积、PWI灌注异常体积、3个月功能预后(mRS评分)及一般临床资料等。根据时间窗中位数将患者分为早期时间窗组和晚期时间窗组。应用统计学方法分析不同时间窗的卒中患者预后差异。结果根据时间窗中位数将患者分为早期时间窗组(≤300 min;118例)和晚期时间窗组(>300 min;82例),两组间治疗前DWI梗死体积和DWI-PWI不匹配体积无明显统计学差异(P>0.05)。然而,与晚期时间窗组相比,早期时间窗组治疗后DWI梗死体积增长较小[11 mL(1~45 mL)与29 mL(3~87 mL)]、3个月良好功能预后比例较高(62.71%与39.02%),差异有统计学意义(t=-2.371,P=0.027;χ^(~2)=10.898,P=0.001)。多元逻辑回归分析显示血管再通程度、(OR 3.75;95%CI:1.43~10.86;P=0.008)、治疗后DWI梗死体积增长(OR 0.73;95%CI:0.58~0.95;P=0.017)、时间窗(OR 0.41;95%CI:0.11~0.79;P=0.005)为预测卒中预后的独立预测因子。结论DWI-PWI不匹配卒中患者的临床预后存在时间依赖性,早期时间窗、血管完全再通和治疗后较小的DWI梗死体积增长有利于卒中的良好功能预后。Objective:We aimed at studying the outcome in acute ischemic stroke with different time windows after mechanical thrombectomy if they present with a diffusion-weighted imaging(DWI)-perfusion-weighted imaging(PWI)mismatch.Materials and Methods:In this retrospective study,200 acute stroke patients who received mechanical thrombectomy in our hospital were enrolled.All patients≤24 hours of symptom onset and underwent MR examination before and after therapy.The vascular recanalization was assessed by mTICI grade.DWI volume,PWI abnormal volume,the functional outcome at 3 months(mRS)and other clinical data were collected.According to the median time window,the patients were divided into early time window and late time window group.Statistical analysis was used to analyze the outcome differences in acute stroke with different time windows.Results:According to the median time window,patients were divided into early time window group(≤300 min;n=118)and late time window group(>300 min;n=82);There was no significant difference in DWI infarct volume on admission and DWI-PWI mismatch volume between two groups(P>0.05).However,compared with late time window group,DWI infarct growth volume[11 mL(1—45 mL)vs.29 mL(3—87 mL)]in early time window group was smaller and the proportion of good functional outcome was higher(62.71%vs.39.02%),the differences showed statistically significant(t=-2.371,P=0.027;χ^(~2)=10.898,P=0.001).Multivariable logistic analysis demonstrated that vascular recanalization(OR,3.75;95%CI:1.43—10.86;P=0.008),DWI infarct growth volume(OR,0.73;95%CI:0.58—0.95;P=0.017)and time window(OR,0.41;95%CI:0.11—0.79;P=0.005)were independently associated with functional outcome.Conclusions:Outcome of acute stroke patients with DWI-PWI mismatch is time-dependent.Early time window,complete vascular recanalization and small DWI infarct growth volume are beneficial to the good functional outcome in acute stroke patients after mechanical thrombectomy.

关 键 词：脑卒中 扩散加权成像 灌注加权成像 预后 时间窗 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743.33[医药卫生—诊断学]