Clinical and perfusion imaging characteristics of acute large vessel occlusion in intracranial atherosclerosis

Hung-Yu Liu; Jeremy J Heit; Nicole Yuen; Chung-Han Yang; Michael Mlynash; Aroosa Zamarud; Ronda Lun; Maarten G Lansberg; Gregory W Albers

doi:10.1016/j.jstrokecerebrovasdis.2024.108024

Clinical and perfusion imaging characteristics of acute large vessel occlusion in intracranial atherosclerosis

J Stroke Cerebrovasc Dis. 2024 Dec;33(12):108024. doi: 10.1016/j.jstrokecerebrovasdis.2024.108024. Epub 2024 Sep 18.

Authors

Hung-Yu Liu¹, Jeremy J Heit², Nicole Yuen³, Chung-Han Yang⁴, Michael Mlynash³, Aroosa Zamarud², Ronda Lun³, Maarten G Lansberg³, Gregory W Albers³

Affiliations

¹ Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. Electronic address: [email protected].
² Department of Radiology, Stanford University School of Medicine, Palo Alto, California, USA.
³ Department of Neurology, Stanford University School of Medicine, Palo Alto, California, USA.
⁴ Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.

PMID: 39303867
DOI: 10.1016/j.jstrokecerebrovasdis.2024.108024

Abstract

Objectives: This study aimed to compare clinical and perfusion imaging profiles in acute ischemic stroke with large vessel occlusion (AIS-LVO) between patients with intracranial atherosclerotic disease (ICAD) and non-ICAD who underwent endovascular treatment (EVT).

Methods: Data from AIS-LVO patients over the anterior circulation undergoing EVT across two stroke centers were retrospectively analyzed. Clinical profiles and perfusion parameters from automated processing of perfusion imaging were compared between ICAD and non-ICAD groups. Ischemic core was defined as relative cerebral blood flow < 30 % on CT perfusion or apparent diffusion coefficient ≤ 620 × 10^-6 mm²/s on MR diffusion weighted imaging.

Results: A total of 111 patients were included (46 ICAD, 65 non-ICAD). The ICAD group exhibited a higher male proportion (60.9 % vs. 35.4 %), more M1 segment occlusions (78.3 % vs. 56.9 %), lower atrial fibrillation rates (17.4 % vs. 63.1 %), and lower baseline NIH Stroke Scale (NIHSS) scores (median [IQR]: 13 [8.75-18] vs. 15 [10-21]) at presentation compared to non-ICAD (all p < 0.05). However, there was no difference in NIHSS scores at discharge or in good functional outcomes (modified Rankin Scale 0-2) at 3 months between the two groups. ICAD patients also had smaller median ischemic core volumes (0 [IQR 0-9.7] vs. 4.4 [0-21.6] ml, p = 0.038), smaller median Tmax >6s tissue volulmes (89.3 [IQR 51.1-147.1] vs. 124.4 [80.5-178.6] ml, p = 0.017) and lower median HIR (hypoperfusion intensity ratio defined as Tmax >10s divided by Tmax >6s; 0.28 [IQR 0.09-0.42] vs. 0.44 [0.24-0.60], p = 0.003). Higher baseline NIHSS scores correlated with larger Tmax >6s lesion volumes as well as higher HIR value in non-ICAD patients, but not in ICAD patients.

Conclusions: In anterior circulation of AIS-LVO, ICAD patients exhibited distinct clinical presentations and perfusion imaging characteristics when compared to non-ICAD patients. Perfusion imaging profiles may serve as indicators for identifying ICAD patients before EVT.

Keywords: Acute ischemic stroke; Endovascular treatment; Intracranial atherosclerosis; Large vessel occlusion; Perfusion imaging.

Publication types

Comparative Study
Multicenter Study

MeSH terms

Aged
Aged, 80 and over
Cerebral Angiography
Cerebrovascular Circulation*
China
Computed Tomography Angiography
Diffusion Magnetic Resonance Imaging*
Disability Evaluation
Endovascular Procedures*
Female
Humans
Intracranial Arteriosclerosis* / diagnostic imaging
Intracranial Arteriosclerosis* / physiopathology
Intracranial Arteriosclerosis* / therapy
Ischemic Stroke* / diagnostic imaging
Ischemic Stroke* / physiopathology
Ischemic Stroke* / therapy
Male
Middle Aged
Perfusion Imaging*
Predictive Value of Tests*
Retrospective Studies
Treatment Outcome