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Clinical and Perfusion Imaging Characteristics of Acute Large Vessel Occlusion in Intracranial Atherosclerosis: Clinical and Perfusion Imaging in ICAD-LVO.
Clinical and Perfusion Imaging Characteristics of Acute Large Vessel Occlusion in Intracranial Atherosclerosis: Clinical and Perfusion Imaging in ICAD-LVO. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association Liu, H. Y., Heit, J. J., Yuen, N., Yang, C. H., Mlynash, M., Zamarud, A., Lun, R., Lansberg, M. G., Albers, G. W. 2024: 108024Abstract
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).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.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.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.
View details for DOI 10.1016/j.jstrokecerebrovasdis.2024.108024
View details for PubMedID 39303867