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• Clinical Article •
A study on predicting the outcome of acute stroke in late-time windows using collateral circulation based on hypoperfusion intensity ratio
CHEN Qian  PENG Mingyang  WANG Tongxing  CHEN Guozhong  YIN Xindao  REN Jun 

Cite this article as: CHEN Q, PENG M Y, WANG T X, et al. A study on predicting the outcome of acute stroke in late-time windows using collateral circulation based on hypoperfusion intensity ratio[J]. Chin J Magn Reson Imaging, 2024, 15(7): 76-80, 93. DOI:10.12015/issn.1674-8034.2024.07.013.


[Abstract] 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.
[Keywords] stroke；magnetic resonance imaging；perfusion imaging；outcome；late-time windows

CHEN Qian   PENG Mingyang   WANG Tongxing   CHEN Guozhong   YIN Xindao   REN Jun*  

Department of Radiology, Nanjing Hospital Affiliated to Nanjing Medical University (Nanjing First Hospital), Nanjing 210006, China

Corresponding author: REN J, E-mail: renjun1203@163.com

Conflicts of interest   None.

Received  2023-12-18
Accepted  2024-06-03
DOI: 10.12015/issn.1674-8034.2024.07.013
Cite this article as: CHEN Q, PENG M Y, WANG T X, et al. A study on predicting the outcome of acute stroke in late-time windows using collateral circulation based on hypoperfusion intensity ratio[J]. Chin J Magn Reson Imaging, 2024, 15(7): 76-80, 93. DOI:10.12015/issn.1674-8034.2024.07.013.

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