Mei Janet, Salim Hamza Adel, Lakhani Dhairya A, Balar Aneri, Vagal Vaibhav, Koneru Manisha, Wolman Dylan, Xu Risheng, Urrutia Victor, Marsh Elisabeth Breese, Pulli Benjamin, Hoseinyazdi Meisam, Luna Licia, Deng Francis, Hyson Nathan Z, Bahouth Mona, Dmytriw Adam A, Guenego Adrien, Albers Gregory W, Lu Hanzhang, Nael Kambiz, Hillis Argye E, Llinas Raf, Wintermark Max, Faizy Tobias D, Heit Jeremy J, Yedavalli Vivek
Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA.
Department of Neuroradiology, MD Anderson Medical Center, Houston, Texas, USA.
J Neuroimaging. 2025 Jan-Feb;35(1):e70015. doi: 10.1111/jon.70015.
Prolonged length of stay (LOS) following a stroke is associated with unfavorable clinical outcomes. Factors predicting LOS in medium vessel occlusion (MeVO), impacting up to 40% of acute ischemic stroke (AIS) cases, remain underexplored. This study aims to investigate the predictors of LOS in AIS-MeVO.
We conducted a retrospective analysis of prospectively maintained stroke databases, comprising AIS cases with MeVO in the anterior circulation, assessed by adequate CT perfusion (CTP). Baseline and clinical data were obtained from electronic health records. Alberta Stroke Program Early CT Scores (ASPECTS) were calculated from non-contrast head CT. The perfusion mismatch volume (time to maximum > 6 s minus relative cerebral blood flow <30%) volume was reported from CTP. Multiple regression was employed to examine the relationship between baseline parameters and hospital LOS.
A total of 133 patients (median age 71 [interquartile range 63-80] years, 59.4% females) were included in the study cohort. The perfusion mismatch volume significantly positively correlated with LOS (r = 0.264, p = 0.004). After adjusting for age, sex, hypertension, diabetes, prior stroke or transient ischemic attack, admission NIHSS, ASPECTS, Tan score, intravenous thrombolysis, mechanical thrombectomy (MT), and hemorrhagic transformation, a larger mismatch volume remained independently associated with longer hospital stays (β = 0.209, 95% confidence interval [CI] 0.006-0.412, p = 0.045). Additional significant determinants of longer hospital stay included admission NIHSS (β = 0.250, 95% CI: 0.060-0.440, p = 0.010) and MT (β = 0.208, 95% CI: 0.006-0.410, p = 0.044). Among patients who underwent MT (n = 83), multiple regression analysis incorporating both perfusion mismatch volume and admission NIHSS revealed that perfusion mismatch volume remained independently associated with LOS (β = 0.248, 95% CI: 0.019-0.471, p = 0.033), while admission NIHSS did not retain significance (β = 0.208, 95% CI: 0.019-0.433, p = 0.071).
In our cohort of AIS patients with MeVO in the anterior circulation, and particularly in those who underwent MT, the perfusion mismatch volume serves as an independent predictor of LOS. These findings offer critical valuable insights in clinical assessments and decision-making protocols of MT in AIS-MeVO.
中风后住院时间延长与不良临床结局相关。中动脉闭塞（MeVO）影响高达40%的急性缺血性中风（AIS）病例，预测其住院时间的因素仍未得到充分研究。本研究旨在调查AIS-MeVO患者住院时间的预测因素。
我们对前瞻性维护的中风数据库进行了回顾性分析，该数据库包括前循环中患有MeVO的AIS病例，并通过充分的CT灌注（CTP）进行评估。基线和临床数据来自电子健康记录。阿尔伯塔中风项目早期CT评分（ASPECTS）由非增强头部CT计算得出。CTP报告灌注失配体积（最大时间>6秒减去相对脑血流量<30%的体积）。采用多元回归分析基线参数与住院时间之间的关系。
研究队列共纳入133例患者（中位年龄71岁[四分位间距63 - 80岁]，女性占59.4%）。灌注失配体积与住院时间显著正相关（r = 0.264，p = 0.004）。在调整年龄、性别、高血压、糖尿病、既往中风或短暂性脑缺血发作、入院时美国国立卫生研究院卒中量表（NIHSS）评分、ASPECTS评分、Tan评分、静脉溶栓、机械取栓（MT）和出血转化后，较大的失配体积仍与更长的住院时间独立相关（β = 0.209，95%置信区间[CI]0.006 - 0.412，p = 0.045）。住院时间延长的其他重要决定因素包括入院时NIHSS评分（β = 0.250，95%CI：0.060 - 0.440，p = 0.010）和MT（β = 0.208，95%CI：0.006 - 0.410，p = 0.044）。在接受MT的患者（n = 83）中，纳入灌注失配体积和入院时NIHSS评分的多元回归分析显示，灌注失配体积仍与住院时间独立相关（β = 0.248，95%CI：0.019 - 0.471，p = 0.033），而入院时NIHSS评分不再具有统计学意义（β = 0.208，95%CI：0.019 - 0.433，p = 0.071）。
在我们的前循环AIS - MeVO患者队列中，特别是在接受MT的患者中，灌注失配体积是住院时间的独立预测因素。这些发现为AIS - MeVO患者MT的临床评估和决策方案提供了关键的有价值见解。
