Successful reperfusion for better outcomes in medium vessel occlusion: Penumbral salvage versus infarct volume reduction

作者：Guangchen He, Tingyu Yi, Jiangshan Deng, Liming Wei, Haitao Lu, Ding-lai Lin, Xiaohui Lin, Yan Zhang, Guihua Miao, Liang Da, Wenhuo Chen, Jingye Wang, Yueqi Zhu · 发表于：European Stroke Journal · 年份：2025 · DOI：10.1177/23969873251360492 · 被引用次数：2 · 研究领域：Acute Ischemic Stroke Management、Peripheral Artery Disease Management、Cerebrovascular and Carotid Artery Diseases

Background: The benefits of endovascular thrombectomy (EVT) over medical treatment for medium vessel occlusion (MeVO) remain uncertain. Understanding how vascular reperfusion leads to favorable outcomes is crucial. This study examines whether penumbra salvage and infarct volume reduction quantify EVT benefits in MeVO patients and assesses their impact on clinical improvement post-reperfusion. Methods: We conducted a multicenter, observational study analyzing MeVO patients who underwent thrombectomy and received multimodal CT imaging from January 2020 to June 2024. EVT efficacy was evaluated by measuring follow-up infarct volume (FIV) on CT scans 24–48 h post-procedure and calculating the penumbra salvage index (PSI). PSI is the ratio of salvaged tissue volume (difference between baseline delay time (DT) >3 s volume and FIV) to baseline DT >3 s volume. Mediation analysis assessed PSI and FIV’s contributions to successful reperfusion and functional outcomes. Results: Of 338 patients, 241 (72%) achieved successful reperfusion. Median FIV was 21 mL (IQR 12–32 mL), and median PSI was 0.68 (IQR 0.50–0.82). Successful reperfusion was linked to a 0.10 increase in PSI (95% CI: 0.05–0.15, p < 0.001) and a 4.36 mL reduction in FIV (95% CI: 1.31–7.20, p = 0.005). Successful reperfusion predicted improved outcomes, with an adjusted odds ratio (aOR) of 1.92 (95% CI: 1.08–3.47, p = 0.020) for excellent outcomes (modified Rankin Scale (mRS) score 0–1) and an aOR of 1.70 (95% CI: 1.0...