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Effect of MR-guided perfusion imaging mismatch profiles within 6 h on endovascular thrombectomy outcomes

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Abstract

Background

The treatment of acute ischemic stroke (AIS) aims to achieve early vascular recanalization and reperfusion of the penumbra. However, the effect of early penumbral imaging within 6 h on clinical outcomes remains unclear. The objective of this study was to determine the effect of magnetic resonance-guided (MR-guided) perfusion imaging within 6 h after symptom onset on endovascular thrombectomy outcomes in AIS patients.

Methods

We prospectively collected the clinical information of consecutive AIS patients undergoing endovascular thrombectomy based on MR-guided perfusion imaging within 6 h after symptom onset from AISRNA and EVTRNA studies. The primary outcome was defined as the poor outcome (mRS > 2 within 90 days). The perfusion-weighted imaging/diffusion-weighted imaging (PWI/DWI) mismatch was assessed by an automated software.

Results

We enrolled 84 patients (25 in the mismatch ≤ 1.8 group and 59 in the mismatch > 1.8 group). Significant difference was found between the mismatch > 1.8 group and the mismatch ≤ 1.8 group for the incidence of disabling stroke (mRS > 2) within 90 days (40.7% vs. 68.0%, OR: 3.099, 95% CI: 1.154–8.323, P = 0.025). Intracranial hemorrhage occurred in 8 patients (13.6%) in the mismatch > 1.8 group and 10 patients in the mismatch ≤ 1.8 group (40.0%) (P = 0.010). The risk of severe cerebral edema was 2/59 (3.4%) vs. 7/25 (28.0%) (P = 0.004). These findings remained stable after adjustment.

Conclusions

MR-guided perfusion imaging mismatch profiles within 6 h after symptom onset may be feasible to predictclinical outcomes and reduce clinically ineffective reperfusion after endovascular thrombectomy.

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Data availability

The original contributions presented in this study are included in the article/Supplementary material, further inquiries can be directed to the corresponding authors.

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Funding

This study was supported by the Medical Scientific Research Project of Jiangsu Commission of Health (ZDA2020019); the Nanjing Medical Science and Technique Development Foundation Project (ZKX22031); the National Science and Technology Innovation 2030–Major Program of Brain Science and Brain-Inspired Intelligence Research (2021ZD0201807); and the Postgraduate Research & Practice Innovation Program of Jiangsu Province (JX12013964 and JX12013960); the Medjaden Academy & Research Foundation for Young Scientists (MJR202310040); the Nanjing Medical University Science and Technique Development Foundation Project (NMUB20220060); the Nanjing Medical Science and Technology Development Foundation (YKK23111).

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Author notes

  1. Xiaohui Li, Zhaomin Lu and Shuo Li these authors contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China

    Xiaohui Li, Zhaomin Lu, Shuo Li, Lin Zhu, Teng Jiang, Junshan Zhou & Qiwen Deng

  2. General Clinical Research Center, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China

    Huiling Sun & Yuqin Pan

  3. Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China

    Qiwen Deng

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  1. Xiaohui Li
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  4. Lin Zhu
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Corresponding authors

Correspondence to Yuqin Pan, Junshan Zhou or Qiwen Deng.

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Study protocol was reviewed and approved by the Ethics Committee of Nanjing First Hospital, Nanjing Medical University (NO. 2019–695). The patients/participants provided written informed consent to participate in this study.

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Li, X., Lu, Z., Li, S. et al. Effect of MR-guided perfusion imaging mismatch profiles within 6 h on endovascular thrombectomy outcomes. Neurol Sci (2024). https://doi.org/10.1007/s10072-024-07751-x

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