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Artery diameter ratio after recanalization in endovascular therapy for acute ischemic stroke: a new predictor of clinical outcomes



This study aimed to investigate the relationship between the artery diameter ratio (ADR) after recanalization and clinical outcomes.


Patients with middle cerebral artery occlusion confirmed by DSA from 1 January 2018, to 31 December 2019, were retrospectively analyzed. All patients confirmed TICI grade 2b or 3. The ADR was calculated as M2 segment diameter/M1 segment diameter. Multivariate regression analysis was used to describe clinical outcomes of two groups (ADR < 0.6 and ≥ 0.6). ROC curves were used to compare different models and find the best cutoff.


A total of 143 patients were included in the study, including 77 males and 66 females, with an average age of 67.79 ± 12 years. The NIHSS at discharge was significantly higher in the ADR < 0.6 group than another group (mean, 16.37 vs. 6.19, P < 0.001). At 90 days, the cases of functional independence was significantly less in the ADR < 0.6 group (20.97% vs. 83.95%, OR 0.05, 95% CI 0.02–0.12, P < 0.001). The ADR < 0.6 group had a higher incidence of cerebral edema (P = 0.027) and sICH (P = 0.038). The ADR had the strongest power to distinguish mRS > 2 (AUC = 0.851) and DC (AUC = 0.805), and the best cutoff value are 0.6 (specificity 85.19%, sensitivity 75.81%) and 0.58 (specificity 65.96%, sensitivity 100%), respectively.


The low ADR is associated with poor outcomes. The decrease in ADR may be an indirect manifestation of the loss of cerebrovascular autoregulation.

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  1. Berkhemer OA, Fransen PS, Beumer D (eds) (2015) A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 372(1): 11-20.

  2. Goyal M, Demchuk AM, Menon BK (eds) (2015) Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 372(11): 1019-30.

  3. Saver JL, Goyal M, Bonafe A (eds) (2015) Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 372(24): 2285–95.

  4. Campbell BC, Mitchell PJ, Kleinig TJ (eds) (2015) Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 372(11): 1009-18.

  5. Jovin TG, Chamorro A, Cobo E (eds) (2015) Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 372(24): 2296-306.

  6. Nogueira RG, Jadhav AP, Haussen DC (eds) (2018) Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. N Engl J Med 378(1): 11–21.

  7. Albers GW, Marks MP, Kemp S (eds) (2018) Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 378(8): 708–718.

  8. Yoon W, Kim SK, Park MS, Baek BH, Lee YY (2017) Predictive factors for good outcome and mortality after stent-retriever thrombectomy in patients with acute anterior circulation stroke. J Stroke 19(1):97–103.

    Article  PubMed  PubMed Central  Google Scholar 

  9. O'Connor KP, Hathidara MY, Danala G (eds) (2020) Predicting clinical outcome after mechanical thrombectomy: the GADIS (gender, age, diabetes mellitus history, infarct volume, and current smoker [corrected]) Score. World Neurosurg 134: e1130-e1142.

  10. Kaschka IN, Kloska SP, Struffert T (eds) (2016) Clinical and radiological outcome after mechanical thrombectomy in acute ischemic stroke: What matters. Neuroradiol J 29(2): 99-105.

  11. Panerai RB (1998) Assessment of cerebral pressure autoregulation in humans—a review of measurement methods. Physiol Meas 19(3):305–338.

    Article  CAS  PubMed  Google Scholar 

  12. Boned S, Padroni M, Rubiera M (eds) (2017) Admission CT perfusion may overestimate initial infarct core: the ghost infarct core concept. J Neurointerv Surg 9(1): 66-69.

  13. Donahue J, Wintermark M (2015) Perfusion CT and acute stroke imaging: foundations, applications, and literature review. J Neuroradio 42(1):21–29.

    Article  Google Scholar 

  14. Angermaier A, Khaw AV, Kirsch M, Kessler C, Langner S (2015) Influence of recanalization and time of cerebral ischemia on tissue outcome after endovascular stroke treatment on computed tomography perfusion. J Stroke Cerebrovasc Dis 24(10):2306–2312.

    Article  PubMed  Google Scholar 

  15. Tong LS, Guo ZN, Ou YB (eds) (2018) Cerebral venous collaterals: a new fort for fighting ischemic stroke. Prog Neurobiol 163-164: 172-193.

  16. Munuera J, Blasco G, Hernández-Pérez M (eds) (2017) Venous imaging-based biomarkers in acute ischaemic stroke. J Neurol Neurosurg Psychiatry 88(1): 62-69.

  17. Tan IY, Demchuk AM, Hopyan J (eds) (2009) CT angiography clot burden score and collateral score: correlation with clinical and radiologic outcomes in acute middle cerebral artery infarct. AJNR Am J Neuroradiol 30(3): 525-31.

  18. Tanriover N, Kawashima M, Rhoton AL Jr, Ulm AJ, Mericle RA (2003) Microsurgical anatomy of the early branches of the middle cerebral artery: morphometric analysis and classification with angiographic correlation. J Neurosurg 98(6):1277–1290.

    Article  PubMed  Google Scholar 

  19. Cilliers K, Page BJ (2017) Anatomy of the middle cerebral artery: cortical branches, branching pattern and anomalies. Turk Neurosurg 27(5):671–681.

    Article  PubMed  Google Scholar 

  20. Sadatomo T, Yuki K, Migita K, Imada Y, Kuwabara M, Kurisu K (2013) Differences between middle cerebral artery bifurcations with normal anatomy and those with aneurysms. Neurosurg Rev 36(3):437–445.

    Article  PubMed  Google Scholar 

  21. Jenkinson D (1999) ECASS-II: intravenous alteplase in acute ischaemic stroke. European Co-operative Acute Stroke Study-II. Lancet 353(9146):67–68.

    Article  CAS  PubMed  Google Scholar 

  22. Lapi D, Colantuoni A (2015) Remodeling of Cerebral Microcirculation after Ischemia-Reperfusion. J Vasc Res 52(1):22–31.

    Article  CAS  PubMed  Google Scholar 

  23. Gibbons GH, Dzau VJ (1994) The emerging concept of vascular remodeling. N Engl J Med 330(20):1431–1438.

    Article  CAS  PubMed  Google Scholar 

  24. Zhang ZG, Chopp M (2009) Neurorestorative therapies for stroke: underlying mechanisms and translation to the clinic. Lancet Neurol 8(5):491–500.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Durukan A, Tatlisumak T (2007) Acute ischemic stroke: overview of major experimental rodent models, pathophysiology, and therapy of focal cerebral ischemia. Pharmacol Biochem Behav 87(1):179–197.

    Article  CAS  PubMed  Google Scholar 

  26. Meyer JS, Denny-Brown D (1955) Studies of cerebral circulation in brain injury. II Cerebral concussion. Electroencephalogr Clin Neurophysiol 7(4):529–544.

    Article  CAS  PubMed  Google Scholar 

  27. Brown MM, Wade JP, Marshall J (1985) Fundamental importance of arterial oxygen content in the regulation of cerebral blood flow in man. Brain 108(Pt 1):81–93.

    Article  PubMed  Google Scholar 

  28. Jeong HG, Kim BJ, Kim H (eds) (2019) Blood pressure drop and penumbral tissue loss in nonrecanalized emergent large vessel occlusion. Stroke 50(10): 2677-2684.

  29. Meyer M, Juenemann M, Braun T (eds) (2020) Impaired cerebrovascular autoregulation in large vessel occlusive stroke after successful mechanical thrombectomy: a prospective cohort study. J Stroke Cerebrovasc Dis 29(3): 104596.

  30. Regenhardt RW, Das AS, Lo EH, Caplan LR (2018) Advances in understanding the pathophysiology of lacunar stroke: a review. JAMA Neurol 75(10):1273–1281.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Goyal N, Tsivgoulis G, Frei D (eds) (2019) Comparative safety and efficacy of modified TICI 2b and TICI 3 reperfusion in acute ischemic strokes treated with mechanical thrombectomy. Neurosurgery 84(3): 680-686.

  32. Ito H, Tomooka T, Sakai N (eds) (1992) Lack of myocardial perfusion immediately after successful thrombolysis. A predictor of poor recovery of left ventricular function in anterior myocardial infarction. Circulation May;85(5):1699–705.

  33. Ito H, Maruyama A, Iwakura K (eds) (1996) Clinical implications of the 'no reflow' phenomenon. A predictor of complications and left ventricular remodeling in reperfused anterior wall myocardial infarction. Circulation Jan 15;93(2):223–8.

  34. Castro P, Azevedo E, Serrador J, Rocha I, Sorond F (2017) Hemorrhagic transformation and cerebral edema in acute ischemic stroke: Link to cerebral autoregulation. J Neurol Sci 372:256–261.

    Article  PubMed  Google Scholar 

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Special thanks to all colleagues for their contribution to this study and continued support. And also special thanks to ZL for the helping in statistical analysis and figure production.


The research belongs to a topic of clinical therapy technology of acute ischemic stroke (item number: 2018XLC2022) and received some grant from it.

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Authors and Affiliations



SH and MZ participated in the conception and design of the study. SH, XL, YW, and WL analyzed and interpreted the data. SH, CL, and MZ treated and included the patients in the study. SH and ZL performed the statistical analysis and wrote the article. All the authors read, reviewed, and approved the manuscript.

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Correspondence to Meng Zhang.

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Ethical approval was obtained from the Ethics Committee of Army Medical Center of PLA Approval of Medical Research Involving People Ethical.

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Huang, S., Liu, C., Li, X. et al. Artery diameter ratio after recanalization in endovascular therapy for acute ischemic stroke: a new predictor of clinical outcomes. Neuroradiology 64, 785–793 (2022).

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