Stroke：梗死体积较血管再通情况能够更好地预测卒中预后

急性缺血性卒中患者进行再通治疗是通过挽救缺血半暗带从而改善临床结果。血管再通情况经常被作为预测疾病结果的重要指标。基于此，美国匹兹堡医学中心大学卒中研究所的Tudor G Jovin博士等人进行了一项研究，研究结果在线发表在2012年11月15日的Stroke杂志上。研究结果发现：成功再通通过减少最终梗死容积改善患者的功能预后。最终梗死容积和年龄是疾病结局的独立预测因素，而血管再通情况不是疾病结局的独立预测因素。

研究人员选定了201位大脑中动脉梗塞的患者。伴有其他梗塞病灶的患者被排除在外。根据前瞻性收据的数据库回顾性分析基线临床/影像学特性、过程性预后（包括溶栓时的脑梗死评分）、临床结果评分（修正的Rankin评分），以及弥散加权上的最后梗死容积。有利结果定义为发病后90天修正的Rankin评分≤2。

研究结果显示：成功再通（脑梗死血栓溶解达到2b级或3级）率达到63.2%，有利结果的比例为46%。再通组平均梗死容积为50.1ml，而未再通组为133.9ml(P<0.01)；有利结果组为40.4ml，而不利结果组为111.8ml(P<0.01)。根据多变量分析，脑梗死血栓溶解≥2b、基线NHISS（美国国立卫生院卒中评分）、Alberta卒中计划早期CT评分和年龄是结果的独立预测因素。但是纳入梗死容积进行分析后发现，只有最终梗死容积和年龄仍然是显着相关。

该研究显示：成功再通通过减少最终梗死容积改善功能结果。在本系列病例分析中，年龄和最终梗死容积而非再通情况是结果的独立预测因素，支持使用最终梗死容积作为急性卒中研究结果标志物的替代。(生物谷Bioon.com)

与卒中相关的拓展阅读：

• Am J Cardiol：急性冠脉综合征和缺血性卒中危险因素相似
• Stroke：超高龄患者的运动和认知能力影响对血压与卒中之间的相关性
• NRR：强制性运动疗法促进脑卒中偏瘫患者的脑功能重组
• Neurology：食用番茄可降低卒中风险
• 糖尿病患者缺血性卒中风险或无种族差异 更多信息请点击：有关卒中更多资讯

Final infarct volume is a stronger predictor of outcome than recanalization in patients with proximal middle cerebral artery occlusion treated with endovascular therapy.
BACKGROUND AND PURPOSE
The rationale for recanalization therapy in acute ischemic stroke is to preserve brain through penumbral salvage and thus improve clinical outcomes. We sought to determine the relationship between recanalization, clinical outcomes, and final infarct volumes in acute ischemic stroke patients presenting with middle cerebral artery occlusion who underwent endovascular therapy and post-procedure magnetic resonance imaging.
METHODS
We identified 201 patients with middle cerebral artery occlusion. Patients with other occlusive lesions were excluded. Baseline clinical/radiological characteristics, procedural outcomes (including thrombolysis in cerebral infarction scores), clinical outcome scores (modified Rankin scores), and final infarct volumes on diffusion weighted imaging were retrospectively analyzed from a prospectively collected database. Favorable outcome is defined as 90-day modified Rankin score≤2.
RESULTS
Successful recanalization (thrombolysis in cerebral infarction grade 2b or 3) was achieved in 63.2% and favorable outcomes in 46% of cases. Mean infarct volume was 50.1 mL in recanalized versus 133.9 mL in non-recanalized patients (P<0.01) and 40.4 mL in patients with favorable outcomes versus 111.8 in patients with unfavorable outcomes (P<0.01). In multivariate analysis, thrombolysis in cerebral infarction≥2b, baseline National Institute of Health Stroke Scale, Alberta Stroke Program Early Computed Tomography scores, and age were identified as independent predictors of outcome. However, when infarct volumes were included in the analysis only final infarct volume and age remained significantly associated.
CONCLUSIONS
Successful recanalization leads to improved functional outcomes through a reduction in final infarct volumes. In our series, age and final infarct volume but not recanalization were found to be independent predictors of outcome, supporting the use of final infarct volume as surrogate marker of outcome in acute stroke trials.