The value of flow visualization map based on CT perfusion in predicting the degree of cerebral edema after endovascular treatment of acute ischemic stroke
Objective:To explore the value of predicting the degree of cerebral edema in ischemic stroke caused by endovascular treatment of anterior circulation occlusion using the flow visualization map(FVM)of CT perfusion(CTP)and to construct a nomogram risk assessment system.Methods:A retrospective analysis was conducted on 63 patients with acute ischemic stroke due to anterior circula-tion occlusion who underwent endovascular treatment(postoperative mTICI grade ≥2b)at our hospi-tal.All patients underwent CTP scanning.The scan source data was transferred to the flow visualiza-tion soft ware to reconstruct the FVM and score it.The ASITN/SIR collateral circulation was assessed based on DSA examination.The degree of cerebral edema was scored(0～3 points)based on re-exami-nation CT,with 0～1 points defined as the mild edema group and 2～3 points defined as the moderate to severe edema group.Differences between the two groups in cardiovascular risk factors,admission NIHSS score,ASPECT score,FVM score,core infarction area volume,hypoperfusion area volume,and ischemic penumbra volume were statistically analyzed.Binary logistic regression was used to identify risk factors for moderate to severe cerebral edema and to construct a nomogram risk model.Receiver operating characteristic(ROC)curves and calibration curves were established to verify the model's ef-fectiveness.Results:There were 44 patients in the mild edema group and 19 patients in the moderate to severe edema group.Univariate analysis showed that the age and core infarction area volume of the mild edema group were smaller than those of the moderate to severe edema group(P＜0.05).The FVM score was higher in the mild edema group compared to the moderate to severe edema group(P＜0.05).Binary logistic analysis indicated that core infarct volume(OR=1.038,95％CI=1.006～1.072,P=0.021)and FVM score(OR=0.268,95％CI=0.116～0.623,P=0.002)were independent predictors of moderate to severe edema.Conclusion:The study demonstrates that core infarct volume and FVM score are independent predictors of moderate to severe cerebral edema in patients with ische-mic stroke due to anterior circulation occlusion treated with endovascular therapy.The nomogram risk model based on these predictors can effectively assess the risk of developing moderate to severe cere-bral edema,aiding in clinical decision-making and patient management.
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