医学
改良兰金量表
水肿
病变
冲程(发动机)
梗塞
置信区间
脑水肿
缺血性中风
缺血
放射科
优势比
内科学
心脏病学
核医学
外科
心肌梗塞
工程类
机械工程
作者
Gabriel Broocks,Rosalie McDonough,Lukas Meyer,Matthias Bechstein,Helge Kniep,Gerhard Schön,Marie Teresa Nawka,Jens Fiehler,Uta Hanning,Peter B. Sporns,Ewgenia Barow,Jens Minnerup,André Kemmling
出处
期刊:Neurology
[Ovid Technologies (Wolters Kluwer)]
日期:2021-09-14
卷期号:97 (11)
被引量:21
标识
DOI:10.1212/wnl.0000000000012484
摘要
Background and Objectives
In acute stroke, early ischemic lesion hypodensity on CT is considered the imaging hallmark of brain infarction, representing a state of irreversible tissue damage with a continual increase of net water uptake. This dogma, however, is challenged by rare cases of apparently reversed early lesion hypodensity after complete reperfusion. The purpose of this study was to investigate the occurrence of reversible ischemic edema after endovascular treatment. Methods
One hundred eighty-four patients with acute ischemic anterior circulation stroke were included after consecutive screening. Ischemic brain edema was determined with quantitative lesion net water uptake (NWU) in admission CT and follow-up CT based on CT densitometry, and ΔNWU was calculated as the difference. The association of edema progression to imaging and clinical parameters was investigated. Clinical outcome was assessed with the modified Rankin Scale (mRS) scores at day 90. Results
Of 184 patients, 27 (14.7%) showed edema arrest and 3 (1.6%) exhibited significant edema reversibility. Higher degree of recanalization (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.46–6.01, p < 0.01) and shorter time from imaging to recanalization (OR per hour 0.32, 95% CI 0.18–0.54, p < 0.0001) were significantly associated with edema arrest or reversibility. Clinical outcome was significantly better in patients without edema progression (median mRS score 2 vs 5, p = 0.004). Discussion
Although rare, lesion hypodensity considered to be representative of early infarct in acute stroke CT may be reversible after complete recanalization. Arrest of edema progression of acute brain infarct lesions may occur after successful rapid vessel recanalization, resulting in improved functional outcome. Future research is needed to investigate conditions in which early revascularization may halt or even reverse vasogenic edema of ischemic tissue.
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