Value of hypoperfusion intensity ratio to the evaluation of prognosis of patients with anterior circulation large-vessel occlusion-acute ischemic stroke
Objective To observe the changes of hypoperfusion intensity ratio(HIR)before endovascular therapy(EVT)in patients with anterior circulation large-vessel occlusion-acute ischemic stroke(LVO-AIS),and to investigate its value to the prediction of 90-d prognosis.Methods Totally 101 patients with anterior circulation LV()-AIS were treated in Xuzhou Central Hospital from August,2022 to October,2023.All patients received EVT within 24 h after onset,and the bridging EVT ratio,EVT type,thrombus removal times,door-to-puncture time(DPT),vascular recalculation time,vascular recalculation situation(modified thrombolysis in cerebral infarction grade 2b or 3),and postoperative complications(massive cerebral edema,pulmonary infection,PH2 type hemorrhage transformation)were recorded.All 101 patients underwent CT/CT angiography(CTA)/CT perfusion imaging before EVT to record responsible cerebral hemisphere,Alberta Stroke Project early CT score(ASPECTS),HIR,regional cerebral blood flow(rCBV),collateral circulation,and hyperdense middle cerebral artery sign(HMCAS).According to the modified Rankin scale score(mRS)90 d after EVT,101 patients were divided into good prognosis group(mRS≤2)and poor prognosis group(mRS＞2),and the stroke risk factors,TOAST etiological classification,progressive stroke rate,time from onset to admission,National Institute of Health stroke scale(NIHSS)on admission,blood pressure,blood glucose,neutrophil count,lymphocyte count,platelet count,neutrophil to lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),and D-dimer elevation rate were recorded.Multivariate logistic regression analysis was performed to analyze the influencing factors of poor prognosis of patients with anterior circulation LVO-AIS 90 d after EVT.ROC curve was plotted to evaluate the efficiencies of the time from onset to admission,preoperative HIR,rCBV and postoperative massive cerebral edema on predicting the poor prognosis 90 d after EVT.Results(1)Among 101 patients,28 underwent bridging EVT,98 got successful reperfusion after EVT,and 3 failed.After 90 d of EVT,the prognosis was good in 36 patients,and poor in 65.(2)The patients were younger in good prognosis group[64(57,74)years old]than in poor prognosis group[67(63,79)years old](P＜0.05).The admission NIHSS score,blood glucose,neutrophils count,NLR,D-dimer elevation rate,HIR,and incidences of significantly decreased rCBV,postoperative massive cerebral edema,pulmonary infection and PH2 type hemorrhage transformation were lower in good prognosis group[13.00(6.00,20.25),5.78(4.89,7.90)mmol/L,4.76(3.56,7.32)× 109/L,3.71(1.95,5.96)％,50.00％,0.01(0,0.03),41.67％,13.89％,22.22％,16.67％]than those in poor prognosis group[18.00(13.00,27.50),6.90(5.70,8.49)mmol/L,5.91(4.85,8.38)× 109/L,5.28(2.71,8.09)％,84.62％,0.17(0.13,0.22),75.38％,73.85％,61.54％,47.69％](P＜0.05).The admission ASPECT score and rate of good collateral circulation were higher in good prognosis group[7(6,8),55.56％]than those in poor prognosis group[5(4,6),21.54％](P＜0.05).There were no significant differences in the gender,stroke risk factors,TOAST etiological classification,and time from onset to admission between two groups(P＞0.05).(3)The time from onset to admission(OR=1.299,95％CI:1.045-1.615,P=0.019),rCBV(OR=14.791,95％CI:1.816-15.944,P=0.033),HIR(OR=1.171,95％CI:1.067-14.190,P=0.008)and postoperative massive cerebral edema(OR=0.036,95％CI:0.007-0.179,P＜0.001)were the influencing factors of poor prognosis 90 d after EVT in patient with anterior circulation LVO-AIS.(4)When the optimal cut-off values of the time from onset to admission and HIR before treatment were 3.975 h and 0.065,the AUCs for predicting poor prognosis 90 d after EVT were 0.612(95％CI:0.491-0.732,P＜0.001)and 0.924(95％CI:0.872-0.977,P＜0.001),the sensitivities were 58.5％and 89.2％,and the specificities were 69.4％and 88.9％,respectively.The AUCs of significantly reduced rCBV and postoperative massive cerebral edema for predicting poor prognosis 90 d after EVT were 0.667(95％CI:0.555-0.782,P＜0.001)and 0.799(95％CI:0.708-0.891,P＜0.001),the sensitivities were 75.4％and 73.8％,and the specificities were 58.3％and 86.1％,respectively.Conclusion The patients with anterior circulation LVO-AIS have an increased risk of poor prognosis 90 d after EVT when the time from onset to admission prolongs,rCBV decreases significantly,postoperative massive cerebral edema develops,and HIR increases,and HIR has a high value to the prediction of the prognosis 90 d after EVT.
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