Value of infarct location in the prediction of functional outcome in patients with an anterior large vessel occlusion: results from the HERMES study,Neuroradiology

当前位置： X-MOL 学术 › Neuroradiology › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Value of infarct location in the prediction of functional outcome in patients with an anterior large vessel occlusion: results from the HERMES study
Neuroradiology ( IF 2.4 ) Pub Date : 2021-09-03 , DOI: 10.1007/s00234-021-02784-x
Manon L Tolhuisen _{1,

2} , Marielle Ernst ₃ , Anne M M Boers ₄ , Scott Brown ₅ , Ludo F M Beenen ₂ , Francis Guillemin ₆ , Yvo B W E M Roos ₇ , Jeffrey L Saver ₈ , Robert van Oostenbrugge _{9,

10} , Andrew M Demchuck ₁₁ , Wim van Zwam ₁₂ , Tudor G Jovin ₁₃ , Olvert A Berkhemer _{2,

14,

15} , Keith W Muir ₁₆ , Serge Bracard _{6,

17} , Bruce C V Campbell _{18,

19} , Aad van der Lugt ₁₆ , Phill White _{20,

21} , Michael D Hill _{11,

22,

23,

24} , Diederik W J Dippel ₁₄ , Peter J Mitchell ₁₉ , Mayank Goyal ₁₁ , Matthan W A Caan ₁ , Henk A Marquering _{1,

2} , Charles B L M Majoie ₂ ,

Affiliation

Department of Biomedical Engineering and Physics, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands.
Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands.
Department of Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen, Göttingen, Germany.
Nico.Lab, www.nico-lab.com, Amsterdam, The Netherlands.
Altair Biostatistics, St Louis Park, MN, USA.
CIC-Epidémiologie Clinique, 1433, Inserm, CHRU, Université de Lorraine, Nancy, France.
Department of Neurology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands.
Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
Department of Neurology, Maastricht UMC, Maastricht, The Netherlands.
Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
Department of Clinical Neurosciences, Department of Radiology and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Department of Radiology, Maastricht UMC, Maastricht, The Netherlands.
Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Institute of Neuroscience and Psychology, University of Glasgow, University Avenue, Glasgow, UK.
Department of Diagnostic and Interventional Neuroradiology, IADI, Inserm, CHRU, Université de Lorraine, Nancy, France.
Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.
Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
Department of Neuroradiology, Newcastle upon Tyne hospitals, Newcastle upon Tyne, UK.
Department of Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
Department of Radiology, Cumming School of Medicine, University of Calgary & Foothills Medical Centre, Calgary, Alberta, Canada.
Department of Medicine, Cumming School of Medicine, University of Calgary & Foothills Medical Centre, Calgary, Calgary, Canada.

Purpose

Follow-up infarct volume (FIV) is moderately associated with functional outcome. We hypothesized that accounting for infarct location would strengthen the association of FIV with functional outcome.

Methods

We included 252 patients from the HERMES collaboration with follow-up diffusion weighted imaging. Patients received endovascular treatment combined with best medical management (n = 52%) versus best medical management alone (n = 48%). FIV was quantified in low, moderate and high modified Rankin Scale (mRS)-relevant regions. We used binary logistic regression to study the relation between the total, high, moderate or low mRS-relevant FIVs and favorable outcome (mRS < 2) after 90 days. The strength of association was evaluated using the c-statistic.

Results

Small lesions only occupied high mRS-relevant brain regions. Lesions additionally occupied lower mRS-relevant brain regions if FIV expanded. Higher FIV was associated with a higher risk of unfavorable outcome, as were volumes of tissue with low, moderate and high mRS relevance. In multivariable modeling, only the volume of high mRS-relevant infarct was significantly associated with favorable outcome. The c-statistic was highest (0.76) for the models that included high mRS-relevant FIV or the combination of high, moderate and low mRS-relevant FIV but was not significantly different from the model that included only total FIV (0.75).

Conclusion

This study confirms the association of FIV and unfavorable functional outcome but showed no strengthened association if lesion location was taken into account.

中文翻译：

梗死部位在预测前大血管闭塞患者功能结果中的价值：HERMES 研究结果

目的

随访梗死体积 (FIV) 与功能结果中度相关。我们假设考虑梗死部位会加强 FIV 与功能结果的关联。

方法

我们纳入了来自 HERMES 合作的 252 名患者，并进行了随访弥散加权成像。患者接受血管内治疗结合最佳医疗管理（n = 52%）与单独的最佳医疗管理（n = 48%）。FIV 在低、中和高改良 Rankin 量表 (mRS) 相关区域进行量化。我们使用二元逻辑回归来研究 90 天后总、高、中或低 mRS 相关 FIV 与有利结果（mRS < 2）之间的关系。使用 c 统计量评估关联强度。

结果

小病灶仅占据与 mRS 相关的高脑区。如果 FIV 扩大，病变还会占据较低的 mRS 相关大脑区域。较高的 FIV 与较高的不利结果风险相关，具有低、中和高 mRS 相关性的组织体积也是如此。在多变量模型中，只有高 mRS 相关梗塞的体积与有利的结果显着相关。对于包含高 mRS 相关 FIV 或高、中和低 mRS 相关 FIV 组合的模型，c 统计量最高 (0.76)，但与仅包含总 FIV (0.75) 的模型没有显着差异。