基于低灌注强度比值的侧支循环对晚期时间窗急性脑卒中预后预测的研究OA北大核心CSTPCD

Objective:To explore the predictive value of hypoperfusion intensity ratio (HIR) in the outcome of late-time windows acute stroke patients after endovascular thrombectomy,using digital subtraction angiography (DSA) as collateral circulation standard. Materials and Methods:A total of 160 acute stroke patients in late-time windows (6-24 hours) receiving endovascular thrombectomy therapy in our study from January 2020 to March 2023 were analyzed retrospectively. American Society of Interventional and Therapeutic Neuroradiology (ASITN) grading system was used to evaluate the collateral circulation (poor collateral circulation:0-2 grade;good collateral circulation:3-4 grade). HIR was defined as the ratio of the time-to-maximum (Tmax)>10 s over Tmax>6 s lesion volumes. Modified Rankin Scale (mRS) score was used to evaluate the outcome at 3 months (good outcome:0-2 score;poor outcome:3-6 score). Spearman rank correlation and receiver operating characteristic (ROC) curve analysis were performed to evaluate the predictive value in the outcome of acute stroke patients in the late-time windows. Results:Compared with the good collaterals group (n=90),the poor collaterals group (n=70) had higher HIR values (0.45±0.07 vs. 0.30±0.08;P<0.001),higher hemorrhagic transformation rates (44.43％ vs. 20.00％;P=0.003),higher early neurological deterioration rates (45.71％ vs. 23.33％;P=0.003),and lower good outcome rates (44.29％ vs. 67.78％;P=0.030). Spearman correlation analysis showed good negative correlation between HIR value and ASITN grading (good outcome group:r=-0.856;P<0.001;poor outcome group:r=-0.888;P<0.001);the HIR value is positively correlated with the mRS score at 3 month (r=0.773;P<0.001). Multivariate logistic regression analysis showed that HIR[OR (95％ CI):0.629 (0.421-1.418);P=0.041]is independent predictors of time from stroke onset. ROC curve analysis showed that there was no significant statistical difference in the predictive efficacy of ASITN grading and HIR in predicting the outcome of acute stroke in the late-time window (AUC:0.837 vs. 0.887;Z=1.696,P=0.090). Conclusions:The evaluation of collateral circulation based on HIR can accurately predict the outcome after endovascular treatment of acute stroke in the late-time windows,providing personalized treatment guidance for clinical practice.