Early haemodynamic predictors of poor functional outcomes in patients with acute ischaemic stroke receiving endovascular therapy: a single-centre retrospective study in China.
Acute ischaemic stroke
Endovascular therapy
Middle cerebral artery
Transcranial color-coded sonography
Journal
PeerJ
ISSN: 2167-8359
Titre abrégé: PeerJ
Pays: United States
ID NLM: 101603425
Informations de publication
Date de publication:
2023
2023
Historique:
received:
15
05
2023
accepted:
18
07
2023
medline:
29
8
2023
pubmed:
28
8
2023
entrez:
28
8
2023
Statut:
epublish
Résumé
Changes in cerebral haemodynamics following endovascular therapy (EVT) for large-vessel occlusion stroke may affect the outcomes of patients with acute ischaemic stroke (AIS); however, evidence supporting this belief is limited. This study aims to identify the early haemodynamic predictors of poor outcomes in patients with AIS caused by anterior circulation large-artery occlusion after undergoing EVT and to evaluate the usefulness of these indicators in predicting functional outcomes at 90 days. This retrospective study was conducted at a single academic hospital, using prospectively collected data. We enrolled adult patients with acute anterior circulation stroke who underwent EVT. Transcranial colour-coded sonography (TCCS) examinations of the recanalised and contralateral middle cerebral artery (MCA) were performed within 12 h after undergoing EVT. Haemodynamic indicators were analysed to determine their association with poor functional outcomes (modified Rankin Scale: 3-6) 90 days after stroke. Receiver operating characteristic (ROC) curves were used to evaluate the usefulness of haemodynamic indicators in predicting functional outcomes. In total, 108 patients (median age: 66 years; 69.4% males) were enrolled in this study. Complete recanalization was achieved in 93 patients (86.1%); however, 60 patients (55.6%) had a poor 90-day outcome. The peak systolic velocity (PSV) ratio, adjusted PSV ratio, mean flow velocity (MFV) ratio, and adjusted MFV ratio of the MCA were significantly higher in patients with poor prognosis than in patients with good prognosis ( Early TCCS examination may help in predicting poor functional outcomes at 90 days in patients with AIS who underwent EVT. Moreover, combining novel TCCS indicators (adjusted MFV ratio) with conventional parameters improved the prediction ability of the base model.
Sections du résumé
Background
Changes in cerebral haemodynamics following endovascular therapy (EVT) for large-vessel occlusion stroke may affect the outcomes of patients with acute ischaemic stroke (AIS); however, evidence supporting this belief is limited. This study aims to identify the early haemodynamic predictors of poor outcomes in patients with AIS caused by anterior circulation large-artery occlusion after undergoing EVT and to evaluate the usefulness of these indicators in predicting functional outcomes at 90 days.
Methods
This retrospective study was conducted at a single academic hospital, using prospectively collected data. We enrolled adult patients with acute anterior circulation stroke who underwent EVT. Transcranial colour-coded sonography (TCCS) examinations of the recanalised and contralateral middle cerebral artery (MCA) were performed within 12 h after undergoing EVT. Haemodynamic indicators were analysed to determine their association with poor functional outcomes (modified Rankin Scale: 3-6) 90 days after stroke. Receiver operating characteristic (ROC) curves were used to evaluate the usefulness of haemodynamic indicators in predicting functional outcomes.
Results
In total, 108 patients (median age: 66 years; 69.4% males) were enrolled in this study. Complete recanalization was achieved in 93 patients (86.1%); however, 60 patients (55.6%) had a poor 90-day outcome. The peak systolic velocity (PSV) ratio, adjusted PSV ratio, mean flow velocity (MFV) ratio, and adjusted MFV ratio of the MCA were significantly higher in patients with poor prognosis than in patients with good prognosis (
Conclusions
Early TCCS examination may help in predicting poor functional outcomes at 90 days in patients with AIS who underwent EVT. Moreover, combining novel TCCS indicators (adjusted MFV ratio) with conventional parameters improved the prediction ability of the base model.
Identifiants
pubmed: 37637153
doi: 10.7717/peerj.15872
pii: 15872
pmc: PMC10448886
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e15872Informations de copyright
©2023 Hu et al.
Déclaration de conflit d'intérêts
The authors declare there are no competing interests.
Références
J Neuroimaging. 2021 Sep;31(5):849-857
pubmed: 34128299
J Neuroimaging. 2018 Jul;28(4):412-415
pubmed: 29655219
Stroke. 2013 Mar;44(3):870-947
pubmed: 23370205
J Neurointerv Surg. 2018 Sep;10(9):882-887
pubmed: 29288194
Neurology. 2021 Nov 16;97(20 Suppl 2):S115-S125
pubmed: 34785610
J Cereb Blood Flow Metab. 2022 Mar;42(3):430-453
pubmed: 34515547
Stroke. 2017 Apr;48(4):983-989
pubmed: 28292867
BMC Neurol. 2015 Oct 07;15:185
pubmed: 26445968
Chin Med J (Engl). 2020 Jul 20;133(14):1655-1661
pubmed: 32604178
World Neurosurg. 2019 May;125:e849-e855
pubmed: 30743030
J Cereb Blood Flow Metab. 2018 Mar;38(3):382-392
pubmed: 28266894
Cerebrovasc Dis Extra. 2014 Aug 26;4(2):186-97
pubmed: 25298773
Open Med (Wars). 2022 Mar 28;17(1):606-613
pubmed: 35434377
Stroke. 2007 Jan;38(1):69-74
pubmed: 17138949
J Neurointerv Surg. 2022 Sep 22;:
pubmed: 36137745
Front Neurol. 2019 Jul 03;10:719
pubmed: 31333570
J Neurol Sci. 2013 Nov 15;334(1-2):26-9
pubmed: 23953946
N Engl J Med. 2015 Sep 10;373(11):1077
pubmed: 26352820
Stroke. 2018 Mar;49(3):e46-e110
pubmed: 29367334
Curr Treat Options Neurol. 2013 Apr;15(2):113-24
pubmed: 23319133
Stroke. 1993 Jan;24(1):35-41
pubmed: 7678184
Neurology. 2019 Jun 11;92(24):e2774-e2783
pubmed: 31092627
Cerebrovasc Dis. 2020;49(2):160-169
pubmed: 32316014
Lancet. 2016 Apr 23;387(10029):1723-31
pubmed: 26898852