Risk factors of unfavorable prognosis for anterior circulation schemic stroke patients with large ischemic core after endovascular treatment
Li Ling, Chen Yuhui, Chen Kunpeng, Wang Guoxuan, Wu Guogeng, Cao Ruoyao, Lu Yao, Zhang Lei, Chen Juan
Abstract
ObjectiveTo assess the prognostic value of the collateral status and clot burden score based on four-dimensional computed tomography angiography(4D CTA)in anteriorcir culation is chemics troke patients with large ischemic core after endovascular treatment.
MethodsClinical and imaging data of 36 anterior circulation ischemic stroke patients with large infarct core (infarct core≥50.0 ml) after endovascular treatment at our institution from March 2016 to September 2020 were retrospectively reviewed. According to the modified Rankin Scale (mRS) score, patients were divided into the good outcome (mRS score 0-2) and poor outcome (mRS score 3-6) groups. Mann-Whitney U and Fisher tests were used to compare the 4D CTA collateral circulation score, clot burden score, and baseline clinical data between the good and poor outcome groups. Multivariate logistic regression was used to analyze the risk factors associated with the poor outcome (mRS score 3-6) and mortality in patients with large infarct core stroke. Finally, based on the 90-day outcome, a ROC curve was used to obtain the cut-off values for poor prognosis (mRS 3-6) and death, respectively.
ResultsTen patients (27.8%) had good outcome and 26 (72.2%) had poor outcome. The patients in the poor outcome group had older median age, higher blood glucose, lower 4D CTA collateral circulation score, lower clot burden score, larger infarct core volume, and higher hemorrhagic transformation and brain hernia (all P<0.05). Multivariate logistic regression showed that the poor collateral circulation score on 4D CTA(OR=0.18, 95%CI: 0.03-0.99, P<0.05)and clot burden score(OR=0.64, 95%CI: 0.44-0.93, P<0.05) were independent predictors of the poor prognosis. The ROC curves revealed that the cut-off value of infarct core for distinguishing between good prognosis and poor prognosis was 63.7 ml, while that for distinguishing between survival and death was 130.3 ml.
ConclusionsEndovascular treatment may improve the prognosis of patients with large infarct core of anterior circulation is chemic stroke if the patients have good 4D CTA collateral circulation score and high clot burden score.
Key words:
Stroke; Acute ischemic stroke; Endovascular treatment; Collateral circulation; Clot burden score
Contributor Information
Li Ling
Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission, Institute of Geriatric Medicine,Chinese Academy of Medical Sciences, Beijing 100730,China
Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China
Chen Yuhui
Department of Neurology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China
Chen Kunpeng
Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine,Chinese Academy of Medical Science,Beijing 100730,China
Wang Guoxuan
Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China
Wu Guogeng
Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China
Cao Ruoyao
Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China
Graduate School of Peking Union Medical College, Beijing 100730, China
Lu Yao
Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission, Institute of Geriatric Medicine,Chinese Academy of Medical Sciences, Beijing 100730,China
Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China
Zhang Lei
Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China
Chen Juan
Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China
