Su Mouxiao, Zhou Ying, Zou Xin, Zhang Shunyuan, Chen Zhonglun
Department of Neurology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang 621000, China.
Department of Radiology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang 621000, China.
J Stroke Cerebrovasc Dis. 2025 Jan;34(1):108150. doi: 10.1016/j.jstrokecerebrovasdis.2024.108150. Epub 2024 Nov 19.
Tissue-level collaterals (TLC), which quantify the state of arterial blood flow transiting through cerebral ischemic tissue, have been shown to be related to the clinical outcomes of acute ischemic stroke (AIS), regardless of the arterial collateral status on computed tomography angiography(CTA). Herein, we investigated whether venous outflow (VO) profiles on computed tomographic perfusion (CTP) were linked to TLC, regardless of the arterial collateral status.
Consecutive anterior circulation AIS patients with large vessel occlusion(LVO) undergoing thrombectomy in a retrospective cohort were evaluated between January 2021 and August 2023 at two comprehensive stroke centers. All patients underwent pretreatment noncontrast computed tomography (NCCT), computed tomography perfusion (CTP) and follow-up NCCT or head magnetic resonance imaging (MRI) within 72 h of endovascular treatment (EVT). The VO profile parameters were recorded based on time-density curve derived from the CTP, including the peak time of VO (PTV) and total VO time (TVT). As the quantitative index of TLC, hypoperfusion intensity ratio (HIR) ≦0.4 was considered favorable for TLC. The primary outcome was tissue-level collaterals (TLC), defined by the HIR. Logistic regression analysis was used to assess the association between VO characteristics and TLC, whereas receiver operating characteristic (ROC) analysis was used to evaluate the value of VO parameters in predicting favorable TLC.
This study enrolled 221 eligible patients, among whom patients with favorable TLC were found to have a shorter PTV than patients with unfavorable TLC (12 s vs.16.5 s, P < 0.001) in univariable analysis. A shorter PTV was significantly associated with a favorable TLC (odds ratio [OR], 0.811; 95% confidence interval [CI], 0.709 to 0.927; P=0.002). Multivariable binary logistic stepwise regression analysis revealed that PTV was negatively correlated with TLC, regardless of the arterial collateral status was good (Good: OR, 0.777; 95%CI, 0.660-0.914; P=0.002; Poor: OR,0.729; 95%CI, 0.569-0.932; P=0.012). ROC analysis revealed that the PTV threshold for predicting favorable TLC was ≤13s, with an area under the curve (AUC), sensitivity, and specificity of 0.754, 0.728, and 0.699, respectively. The comprehensive predictor combined with PTV had an optimal predictive ability for TLC with an AUC of 0.894 (sensitivity=0.839, specificity=0.864).
Cerebral VO profiles in patients with anterior circulation AIS with LVO were related to TLC regardless of arterial collateral status, while PTV≤13s was a good predictor of favorable TLC.
组织水平侧支循环（TLC）用于量化流经脑缺血组织的动脉血流状态，已被证明与急性缺血性卒中（AIS）的临床结局相关，无论计算机断层扫描血管造影（CTA）上的动脉侧支循环状态如何。在此，我们研究了计算机断层扫描灌注（CTP）上的静脉流出（VO）情况是否与TLC相关，而不考虑动脉侧支循环状态。
在2021年1月至2023年8月期间，对两个综合卒中中心连续收治的接受血栓切除术的前循环大血管闭塞（LVO）AIS患者进行回顾性队列研究。所有患者在血管内治疗（EVT）后72小时内接受治疗前非增强计算机断层扫描（NCCT）、计算机断层扫描灌注（CTP）以及随访NCCT或头部磁共振成像（MRI）。基于CTP得出的时间-密度曲线记录VO情况参数，包括VO的峰值时间（PTV）和总VO时间（TVT）。作为TLC的定量指标，灌注不足强度比（HIR）≤0.4被认为TLC良好。主要结局是由HIR定义的组织水平侧支循环（TLC）。采用逻辑回归分析评估VO特征与TLC之间的关联，而采用受试者工作特征（ROC）分析评估VO参数在预测良好TLC方面的价值。
本研究纳入221例符合条件的患者，单因素分析发现，TLC良好的患者PTV短于TLC不良的患者（12秒对16.5秒，P<0.001）。PTV较短与良好的TLC显著相关（比值比[OR]，0.811；95%置信区间[CI]，0.709至0.927；P=0.002）。多因素二元逻辑逐步回归分析显示，无论动脉侧支循环状态良好（良好：OR，0.777；95%CI，0.660 - 0.914；P=0.002；不良：OR，0.729；95%CI，0.569 - 0.932；P=0.012），PTV与TLC呈负相关。ROC分析显示，预测良好TLC的PTV阈值≤13秒，曲线下面积（AUC）、敏感性和特异性分别为0.754、0.728和0.699。结合PTV的综合预测指标对TLC具有最佳预测能力，AUC为0.894（敏感性=0.839，特异性=0.864）。
前循环LVO的AIS患者的脑VO情况与TLC相关，而不考虑动脉侧支循环状态，PTV≤13秒是良好TLC的良好预测指标。
