Predictive value of CT perfusion imaging on the outcome after mechanical thrombectomy in patients with anterior circulation large vessel occlusive stroke / 国际脑血管病杂志

ABSTRACT

Objective:To investigate the predictive value of CT perfusion imaging (CTP) parameters on the outcome after mechanical thrombosis (MT) in patients with anterior circulation acute ischemic stroke due to large vessel occlusion (LVO-AIS).Methods:The clinical data of patients with LVO-AIS received MT treatment in Taizhou People’s Hospital from July 2019 to June 2021 and achieved modified Thrombolysis in Cerebral Infarction (mTICI) blood flow grade 2b or above were retrospectively enrolled. RAPID software was used to automatically conduct image post-processing to obtain CTP parameters. The patients were divided into good outcome group (≤2) and poor outcome group (>2) according to the modified Rankin Scale score at 90 days after procedure. Multivariate logistic regression analysis was used to screen the CTP parameters that affect the outcomes. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of CTP parameters for poor outcomes. Results:A total of 88 patients with LVO-AIS were enrolled, including 52 males (59.1%), with a median age of 71 years (range 58-78 years), and the median baseline National Institutes of Health Stroke Scale (NIHSS) score of 14 (range, 11-17). Eleven patients (12.5%) received intravenous thrombolytic bridging MT, and 77 (87.5%) received direct MT. Forty-seven patients (53.4%) had good outcomes and 41 (46.6%) had poor outcomes at 90 d after procedure. Univariate analysis showed that there were significant differences in baseline NIHSS score, vascular occlusion site, baseline Alberta Stroke Program Early CT Score, the number of retrieval attempts, V CBF<30%, V Tmax>6 s, V CBF>30%/mismatch volume and hypoperfusion intensity ratio (HIR) between the poor outcome group and the good outcome group (all P<0.05). Multivariable logistic regression analysis showed that atrial fibrillation (odds ratio [ OR] 6.200, 95% confidence interval [ CI] 1.225-31.374; P=0.027), baseline NIHSS score ( OR 1.188, 95% CI 1.00-1.404; P=0.043) and V CBF<30% ( OR 1.079, 95% CI 1.03-1.123; P=0.027) were the independent influencing factors of poor outcomes. ROC curve analysis showed that the areas under the curve of atrial fibrillation, baseline NIHSS score, V CBF<30% and their combined for predicting the poor outcoms were 0.675, 0.739, 0.882 and 0.914, respectively. V CBF<30% had the highest diagnostic efficiency in predicting poor outcomes of the single factor. When the cutoff value was 16 ml, the sensitivity and specificity were 82.9% and 78% respectively. Conclusions:RAPID software analysis parameters based on CTP can be used to predict the clinical outcomes after MT in patients with LVO-AIS. V CBF<30% >16 ml has a higher predictive value for poor outcomes after MT.