Background and Purpose

Isolated Sulcal Effacement (ISE) is focal cortical swelling without obscuration of cortical gray-white junction. The available information on its role in acute stroke patients treated with intravenous (IV) tissue plasminogen activator (tPA) is limited.

Methods

ISE along with ASPECT and rLMC collateral score were determined in pre-treatment CT/CT angiography of 195 consecutive acute stroke patients treated with IV tPA “only”. In addition, ISE-ASPECT score was created. Role of ISE on responsiveness to IV tPA, thrombolysis-associated hemorrhage and functional outcome were studied in 102 patients with CT-angiography-confirmed anterior system proximal vessel occlusion.

Results

ISE was observed in 12 patients (6.2% of all and 11.4% of those with occlusion of the carotid terminus, M1, or proximal M2) corresponding to excellent specificity (100%) but fair sensitivity (12%) for diagnosis of anterior cerebral circulation proximal artery occlusion. ISE ASPECT score was significantly correlated with rLMC score (p=0.023). Presence of ISE was linked to younger age, female gender, lower NIHSS, along with higher ASPECT and rLMC scores. Albeit not persisted after adjustment for collateral status and NIHSS, dramatic response to IV tPA along with excellent (23% vs. 8%, p<0.05), good (21% vs. 6%, p<0.05) and acceptable (19% vs. 4%, p<0.05) functional outcome were significantly higher in patients with ISE.

Conclusions

As a plain CT marker of sufficient collateral status and increased cerebral blood volume, ISE indicates a better response to IV tPA. However, it should be noted that this relatively rare CT finding is highly specific for cerebral large vessel occlusions amenable neurothrombectomy.

中文翻译：

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急性缺血性卒中中孤立的沟渠面和静脉溶栓反应。

背景和目的

孤立的沟渠面（ISE）是局灶性皮质肿胀，而皮质灰白色交界处没有遮盖。关于其在接受静脉内（IV）组织纤溶酶原激活剂（tPA）治疗的急性中风患者中作用的可用信息有限。

方法

在195例接受IV tPA治疗的连续急性卒中患者的“治疗前CT / CT血管造影”中确定了ISE以及ASPECT和rLMC侧支评分。另外，创建了ISE-ASPECT分数。在102例经CT血管造影证实前系统近端血管闭塞的患者中，研究了ISE对IV tPA反应性，溶栓相关性出血和功能结局的作用。

结果

在12例患者中观察到ISE（占颈总站，M1或近端M2闭塞的全部患者的6.2％，占所有患者的11.4％），其特异性极佳（100％），但对诊断前脑循环的敏感性相当（12％）近端动脉闭塞。ISE ASPECT得分与rLMC得分显着相关（p = 0.023）。ISE的存在与年龄，女性，NIHSS降低，ASPECT和rLMC得分较高有关。调整侧支状态和NIHSS后仍未坚持，对IV tPA的反应显着，优良（23％vs. 8％，p <0.05），良好（21％vs. 6％，p <0.05）和可接受（19％）与4％（p <0.05）相比，ISE患者的功能预后明显更高。

结论

ISE作为具有足够侧支状态和脑血容量增加的普通CT标记物，表明对IV tPA有更好的反应。但是，应该注意的是，这种相对罕见的CT发现对于脑大血管闭塞性神经血栓切除术具有高度特异性。