目的 探讨弥散加权成像(diffusion-weighted imaging,DWI)相对信号强度(relative DWI signal intensity,DWI-rSI)对血管内机械血栓切除术(endovascular therapy,EVT)后血管成功再通的心源性栓塞所致前循环大血管闭塞性卒中患者转归的预测作用.方法 回顾性纳入2017年3月至2023年3月在扬州大学附属医院接受EVT后血管成功再通的心源性栓塞所致前循环大血管闭塞性卒中患者.根据术后3个月改良Rankin量表评分分为转归良好组(0～2分)和转归不良组(3～6分).应用多变量logistic回归分析确定转归不良的独立预测因素.结果 共纳入59例患者,男性29例(49.2％),中位年龄74岁(四分位数间距:68～80岁);中位基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分 15 分(12～21 分),中位 DWI-阿尔伯塔卒中项目早期 CT评分(Alberta Stroke Program Early CT Score,ASPECTS)8分(5～9分).32例(54.2％)转归良好,27例(45.8％)转归不良,其中9例(15.3％)患者死亡(6例死于恶性脑水肿后脑疝形成,2例死于并发症,1例死于术后颅内严重出血).21例(35.6％)发生出血性转化,包括12例(20.3％)有症状颅内出血.转归良好组基线收缩压、NIHSS评分、DWI-ASPECTS、DWI-rSI以及有症状颅内出血发生率与转归不良组差异有统计学意义(P均＜0.05).多变量logistic回归分析显示,基线收缩压(优势比0.977,95％置信区间 0.919～0.991;P=0.015)和 DWI-rSI(优势比 11.809,95％置信区间 1.932～72.170;P=0.008)为转归不良的独立预测因素.结论 DWI-rSI可预测EVT后血管成功再通的心源性栓塞所致前循环大血管闭塞性卒中患者的转归.
Relative diffusion-weighted imaging signal intensity predicts outcome in cardioembolic stroke patients with successful recanalization after endovascular treatment
Objective To investigate the predictive role of relative diffusion-weighted imaging(DWI)signal intensity(DWI-rSI)in outcome in patients with anterior circulation large vessel occlusion cardioembolic stroke and successful recanalization after endovascular therapy(EVT).Methods Patients with anterior circulation large vessel occlusion stroke due to cardioembolic embolism underwent EVT and successful recanalization at the Affiliated Hospital of Yangzhou University from March 2017 to March 2023 were retrospectively included.According to the modified Rankin Scale score 3 months after procedure,the patients were divided into a good outcome group(0-2 points)and a poor outcome group(3-6 points).Multivariate logistic regression analysis was used to identify independent predictive factors for poor outcome.Results A total of 59 patients were enrolled,including 29 males(49.2％),median age of 74 years(interquartile range,68-80 years).The median baseline National Institutes of Health Stroke Scale(NIHSS)score was 15(12-21),and the median DWI Alberta Stroke Program Early CT Score(ASPECTS)was 8(5-9).Thirty-two patients(54.2％)had good outcome,and 27(45.8％)had poor outcome.Among them,9 patients(15.3％)died(6 died from cerebral herniation after malignant brain edema,2 died from complications,and 1 died from severe intracranial hemorrhage after procedure).Twenty-one patients(35.6％)experienced hemorrhagic transformation,including 12(20.3％)with symptomatic intracranial hemorrhage.There were significant differences in baseline systolic blood pressure,NIHSS score,DWI-ASPECTS,DWI-rSI,and incidence of symptomatic intracranial hemorrhage between the good outcome group and the poor outcome group(all P＜0.05).Multivariate logistic regression analysis showed that baseline systolic blood pressure(odds ratio 0.977,95％confidence interval 0.919-0.991;P=0.015)and DWI-rSI(odds ratio 11.809,95％confidence interval 1.932-72.170;P=0.008)were the independent predictors for poor outcome.Conclusion DWI-rSI can predict the outcome of patients with anterior circulation large vessel occlusion cardioembolic stroke and successful recanalization after EVT.
Ischemic strokeEmbolic strokeDiffusion magnetic resonance imagingEndovascular proceduresThrombectomyReperfusionTreatment outcome
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