Objectives

Despite the proven efficacy of endovascular thrombectomy (EVT) for large vessel occlusion stroke, over half treated remain functionally disabled or die. Infarct topography may have implications for prognostication, patient selection, and the development of tissue-specific neuroprotective agents. We sought to quantify white matter injury in anterior circulation acute infarcts post-EVT to understand its significance and identify its determinants.

Materials and Methods

Demographics, history, presentations, and outcomes for consecutive patients treated with EVT were recorded in a prospectively maintained database at a single center. Acute infarct masks were coregistered to standard space. Standard atlases of white matter, cortex, and basal ganglia were used to determine region-specific infarct volumes.

Results

167 individuals were identified with median age 69 years and 53% women. 85% achieved adequate reperfusion (TICI 2b-3) after EVT; 43% achieved 90-day functional independence (mRS 0-2). Median infarct volumes were 45cc (IQR 18-122) for total, 17cc (6-49) for white matter, 21cc (4-53) for cortex, and 5cc (1-8) for basal ganglia. The odds of 90-day mRS 0-2 were reduced in patients with larger white matter infarct volume (cc, OR=0.89, 95%CI=0.81-0.96), independent of cortex infarct volume, basal ganglia infarct volume, age, NIHSS, and TICI 2b-3 reperfusion. Reperfusion-to-MRI time was associated with white matter infarct volume (hr, β=0.119, p=0.017), but not cortical or basal ganglia infarct volume.

Conclusions

These data quantitatively describe region-specific infarct volumes after EVT and suggest the clinical relevance of white matter infarct volume as a predictor of long-term outcomes. Further study is warranted to examine delayed white matter infarction and the significance of specific white matter tracts.

中文翻译：

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前循环大血管闭塞中风取栓后白质急性梗死体积与长期预后相关

目标

尽管血管内血栓切除术 (EVT) 已证明对大血管闭塞性卒中有效，但超过一半的治疗仍然功能障碍或死亡。梗塞地形可能对预后、患者选择和组织特异性神经保护剂的开发有影响。我们试图量化 EVT 后前循环急性梗塞中的白质损伤，以了解其意义并确定其决定因素。

材料和方法

连续接受 EVT 治疗的患者的人口统计、病史、表现和结果记录在单个中心的前瞻性维护数据库中。急性梗塞面罩被共同配准到标准空间。白质、皮层和基底神经节的标准图谱用于确定区域特异性梗塞体积。

结果

167 人被确定为中位年龄 69 岁，53% 为女性。EVT 后 85% 达到充分再灌注 (TICI 2b-3)；43% 实现了 90 天的功能独立（mRS 0-2）。梗死体积中位数为 45cc (IQR 18-122)，白质 17cc (6-49)，皮质 21cc (4-53)，基底节 5cc (1-8)。白质梗死体积较大（cc，OR=0.89，95%CI=0.81-0.96）的患者发生 90 天 mRS 0-2 的几率降低，与皮层梗死体积、基底节梗死体积、年龄、NIHSS 无关和 TICI 2b-3 再灌注。再灌注至 MRI 时间与白质梗死体积相关（hr，β=0.119，p=0.017），但与皮质或基底节梗死体积无关。

结论

这些数据定量地描述了 EVT 后特定区域的梗死体积，并表明白质梗死体积的临床相关性作为长期结果的预测因子。需要进一步研究来检查延迟性白质梗死和特定白质束的重要性。