Shah Smit, Wood Stefanie, Logue Lawson, Meyer Jaclyn, Pikel Karly, Germroth Matthew, Peethamber Gowri, Kodumuri Nishanth, Lowe Forrest Justin, Kothari Ravish, Rahman Line, Venkatesh Swamy, Sen Souvik
University of South Carolina School of Medicine and Prisma Health Midlands, Department of Neurology, Columbia, SC.
J Stroke Cerebrovasc Dis. 2025 Feb;34(2):108211. doi: 10.1016/j.jstrokecerebrovasdis.2024.108211. Epub 2024 Dec 22.
Hypoperfusion index ratio (HIR) measured by computerized tomography perfusion (CTP) has been shown to predict collateral flow state in acute ischemic stroke (AIS). Low HIR (<0.4) is indicative of good collateral flow state. This study tested the association between good collateral flow state and stroke severity and clinical outcome at discharge.
Data from AIS patients who underwent CTP during initial stroke evaluation were linked with Get With the Guideline database between 2018 and 2020. Patients with good collateral flow (HIR < 0.4) were compared to those with poor collateral flow (≥0.4). They were stratified based on modified Rankin Score (mRS) at discharge into good (mRS 0-2) or poor (mRS 3-6) outcomes. A collateral score of 0-3 was assigned using CTA's obtained at the time of AIS presentation. We used univariate and multivariable logistic regression analyses to test the association between good collateral flow state and good discharge outcome.
CT perfusion data was obtained in 1442 patients. After exclusions, 391 patients (age 69 ± 14, 54% male, 48% white, 52% black/others) remained, of whom 295 (75%) demonstrated good collateral flow and 96 (25%) showed poor collateral flow. Those with good collateral flow were younger (69 ± 14 vs. 71 ± 15, p = 0.25) and lower median NIHSS [7 (25-75%ile 3-13) vs. 14 (25-75%ile 8-20), p < 0.001]. CTA collateral scores demonstrated a significant inverse correlation to HIR. Good collateral flow was associated with good outcome on discharge (OR 2.7, 95% CI 1.4-5.1). The association remained significant after adjustment for demographics and comorbidities (adjusted OR 3.2 (1.7-6.4).
In patients presenting with AIS who were non-thrombectomy candidates, good collateral flow state measured by HIR on CTP was associated with good functional outcome at discharge after adjustment for comorbidities.
计算机断层扫描灌注（CTP）测量的低灌注指数比（HIR）已被证明可预测急性缺血性卒中（AIS）的侧支血流状态。低HIR（<0.4）表明侧支血流状态良好。本研究测试了良好侧支血流状态与卒中严重程度及出院时临床结局之间的关联。
2018年至2020年期间，将初始卒中评估时接受CTP检查的AIS患者的数据与“遵循指南”数据库相链接。将侧支血流良好（HIR<0.4）的患者与侧支血流差（≥0.4）的患者进行比较。根据出院时的改良Rankin评分（mRS）将他们分为良好（mRS 0 - 2）或不良（mRS 3 - 6）结局。使用AIS发病时获得的CTA分配0 - 3的侧支评分。我们使用单变量和多变量逻辑回归分析来测试良好侧支血流状态与良好出院结局之间的关联。
1442例患者获得了CT灌注数据。排除后，391例患者（年龄69±14岁，54%为男性，48%为白人，52%为黑人/其他种族）留存，其中295例（75%）侧支血流良好，96例（25%）侧支血流差。侧支血流良好的患者更年轻（69±14岁对71±15岁，p = 0.25），且美国国立卫生研究院卒中量表（NIHSS）中位数更低[7（四分位数间距25 - 75%为）3 - 13]对14（四分位数间距25 - 75%为8 - 20），p<0.001]。CTA侧支评分与HIR呈显著负相关。良好的侧支血流与出院时的良好结局相关（比值比2.7，95%置信区间1.4 - 5.1）。在调整人口统计学和合并症后，该关联仍然显著（调整后比值比3.2（1.7 - 6.4）。
在不适合进行血栓切除术的AIS患者中，经CTP测量的HIR显示良好的侧支血流状态在调整合并症后与出院时的良好功能结局相关。
