Combined collaterals and hemodynamic features to predict the prognosis in acute ischemic stroke patients undergoing mechanical thrombectomy

Zhiruo Song; Xiang Fang; Xuerong Jia; Rui Liu; Dong Yang; Anyu Liao; Feiluola Kasaer; Yan Xu; Zhiguo Zhang; Wusheng Zhu; Kangmo Huang; Xinfeng Liu

doi:10.1136/jnis-2024-022428

Combined collaterals and hemodynamic features to predict the prognosis in acute ischemic stroke patients undergoing mechanical thrombectomy

J Neurointerv Surg. 2024 Dec 23:jnis-2024-022428. doi: 10.1136/jnis-2024-022428. Online ahead of print.

Authors

Zhiruo Song^#¹, Xiang Fang^#², Xuerong Jia³, Rui Liu³, Dong Yang³, Anyu Liao³, Feiluola Kasaer³, Yan Xu⁴, Zhiguo Zhang⁴, Wusheng Zhu³, Kangmo Huang⁵, Xinfeng Liu⁶

Affiliations

¹ Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China.
² Advanced Propulsion Laboratory, Department of Modern Mechanics, University of Science and Technology of China, Hefei, China.
³ Department of Neurology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
⁴ Neusoft Medical Systems Co Ltd, Shenyang, China.
⁵ Department of Neurology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China [email protected] [email protected].
⁶ Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China [email protected] [email protected].

^# Contributed equally.

PMID: 39715668
DOI: 10.1136/jnis-2024-022428

Abstract

Background: Despite successful recanalization via mechanical thrombectomy (MT), only half of acute ischemic stroke (AIS) patients achieve functional independence. Post-MT hemodynamic features are insufficiently investigated, and the lack of bilateral comparisons limits individual assessment. Therefore, we aimed to explore how individualized hemodynamic features affect functional outcomes using quantitative digital subtraction angiography (Q-DSA).

Methods: We screened three prospective databases for anterior circulation AIS participants with successful recanalization via MT. Hemodynamic features, including time to peak (TTP), were measured for four regions of interest (ROIs) on each side with Q-DSA. ROI_C2 served as a reference for correcting TTP values. We defined TTP variation (TTPV), as the degree of difference in TTP between the symptomatic and the healthy sides. A composite indicator, integrating TTPV and collateral status, was developed to reflect comprehensive perfusion capacity. Multivariable logistic regression was employed to investigate the association between TTPV, or the composite indicator, and functional outcomes (90-day modified Rankin Scale <2).

Result: Finally, 201 participants (median (interquartile range (IQR) age 68 (57, 75] years, 64.2% males) were enrolled, and 97 (48.3%) patients achieved favourable functional outcomes. TTPV_C2-M1 was significantly related to favorable functional outcome (adjusted OR (aOR) = 0.627; 95% confidence interval (0.407, 0.966); p=0.034). Additionally, the composite indicator of good collaterals and low TTPV_C2-M1 was a powerful predictor for the favorable outcome (aOR=6.693; 95% confidence interval (2.652, 16.896); P<0.001).

Conclusion: TTPV_C2-M1 and the composite perfusion indicator showed significant predictive value in prognosis and potentially guided intra-procedure interventions and subsequent management among AIS patients.

Keywords: Angiography; Blood Flow; Stroke; Thrombectomy.