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Ischemic stroke
Original research
Combined collaterals and hemodynamic features to predict the prognosis in acute ischemic stroke patients undergoing mechanical thrombectomy
  1. Zhiruo Song1,
  2. Xiang Fang2,
  3. Xuerong Jia3,
  4. Rui Liu3,
  5. Dong Yang3,
  6. Anyu Liao3,
  7. Feiluola Kasaer3,
  8. Yan Xu4,
  9. Zhiguo Zhang4,
  10. Wusheng Zhu3,
  11. Kangmo Huang3,
  12. Xinfeng Liu1
  1. 1Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China
  2. 2Advanced Propulsion Laboratory, Department of Modern Mechanics, University of Science and Technology of China, Hefei, China
  3. 3Department of Neurology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
  4. 4Neusoft Medical Systems Co Ltd, Shenyang, China
  1. Correspondence to Prof. Xinfeng Liu; xfliu2{at}vip.163.com; Dr Kangmo Huang; mozi0711{at}163.com

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. ROIC2 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. TTPVC2-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 TTPVC2-M1 was a powerful predictor for the favorable outcome (aOR=6.693; 95% confidence interval (2.652, 16.896); P<0.001).

Conclusion TTPVC2-M1 and the composite perfusion indicator showed significant predictive value in prognosis and potentially guided intra-procedure interventions and subsequent management among AIS patients.

  • Stroke
  • Angiography
  • Blood Flow
  • Thrombectomy

Data availability statement

Data are available upon reasonable request. Data are available from the corresponding authors upon reasonable request.

https://doi.org/10.1136/jnis-2024-022428

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    Data availability statement

    Data are available upon reasonable request. Data are available from the corresponding authors upon reasonable request.

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    Footnotes

    • ZS and XF contributed equally.

    • Contributors ZS was responsible for conceptualization, formal analysis, and original draft preparation. XF was responsible for conceptualization and methodology. XJ contributed to formal analysis, visualization, and editing. RL contributed to data collection and investigation. DY contributed to data collection and validation. AL contributed to data curation and reviewing. FK contributed to investigation and visualization. YX contributed to software and methodology. ZZ contributed to software and supervision. WZ contributed to supervision and reviewing. KH contributed to conceptualization, reviewing, and editing. XL was responsible for the overall content and was the guarantor.

    • Funding This study has received funding from the National Natural Science Foundation of China (U22A20341), the Medical Research Project of Jiangsu Provincial Health Commission (H2023117), and the Jiangsu Funding Program for Excellent Postdoctoral Talent (2022ZB752).

    • Competing interests YX and ZZ are employees of Neusoft Medical Systems Co., Ltd. The other authors report no conflicts of interest.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.