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Predicting 3-month Functional Outcome After Endovascular Thrombectomy in Patients with Anterior Circulation Occlusion with an Arterial Transit Artifact Grading System

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Abstract

Purpose

The objective of this study was to evaluate the relationship between arterial transit artifact (ATA), arterial spin labeling (ASL) perfusion imaging, and the outcome of patients with acute ischemic stroke (AIS) due to occlusion of large vessels in anterior circulation after endovascular thrombectomy (EVT).

Methods

Patients with anterior circulation occlusion treated with EVT between October 2017 and December 2021 were enrolled in this retrospective study, and ATA was quantified by a 4-point scale. A favorable outcome was defined by modified Rankin Scale (mRS) scores of 0–2 at 3 months. To identify independent predictors of favorable outcome, age, sex, risk factors, baseline National Institutes of Health Stroke Scale (NIHSS) score, site of occlusion, cause of stroke, and early reperfusion were evaluated with univariate and multivariate analyses. Predictive accuracy was evaluated by calculating the area under the receiver operating characteristic (ROC) curve (AUC) for the model.

Results

In this study 187 patients (age, 65.0 ± 12.5 years; men, 55%) were evaluated. Younger age (odds ratio, OR, 0.95; 95% confidence interval, CI, 0.92–0.98, p = 0.002), lower baseline NIHSS score (OR, 0.88; 95% CI, 0.82–0.94, p < 0.001), and lower ATA score (OR, 1.14; 95% CI, 1.06–1.22, p < 0.001) were independently associated with favorable outcomes in multivariate analysis. The ATA score has moderate to good accuracy in predicting favorable outcomes (AUC, 0.753).

Conclusion

A high ATA score as a potential predictor, can help identify patients who may benefit from EVT.

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Abbreviations

AIS:

Acute ischemic stroke

ASL:

Arterial spin labeling

ASPECTS:

Alberta Stroke Program Early CT Score

ATA:

Arterial transit artifact

ATT:

Arterial transit time

AUC:

Area under the curve

CTA:

Computerized tomography angiography

DSA:

Digital subtraction angiography

DWI:

Diffusion-weighted imaging

EVT:

Endovascular thrombectomy

FLAIR:

Fluid-attenuated inversion recovery

ICAS‑O:

Intracranial atherosclerosis-related occlusion

mRS:

Modified Rankin Scale

mTICI:

Modified treatment in cerebral infarction

NIHSS:

National Institutes of Health Stroke Scale

PLD:

Postlabeling delay

ROC:

Receiver operating characteristic

TIA:

Transient ischemic attack

tPA:

Tissue plasminogen activator

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Acknowledgements

The authors thank AiMi Academic Services (www.aimieditor.com) for English language editing and review services.

Funding

This study was supported by Xi’an Science and Technology Planning Project (21YXYJ0004), Natural Science Basic Research Project of Shaanxi Province (2022JM-452).

Author information

Authors and Affiliations

  1. The College of Life Sciences, Northwest University, Xi’an, China

    Xiaobo Zhang, Yu Zhang, Wenting Yuan & Shangguang Kan

  2. Department of Neurology, Xi’an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi’an, China

    Xiaobo Zhang, Nannan Han, Gejuan Zhang, Haojun Ma, Hanming Ge, Chengxue Du, Shilin Li, Xudong Yan, Ye Tian & Mingze Chang

  3. Department of Radiology, Xi’an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi’an, China

    Yanjun Gao

  4. Medical Research Center, Xi’an Key Laboratory of Cardiovascular and Cerebrovascular Diseases, Xi’an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi’an, China

    Wenzhen Shi & Ye Tian

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  1. Xiaobo Zhang
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Correspondence to Ye Tian or Mingze Chang.

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Conflict of interest

X. Zhang, N. Han, Y. Zhang, W. Yuan, S. Kan, G. Zhang, H. Ma, H. Ge, C. Du, Y. Gao, S. Li, X. Yan, W. Shi, Y. Tian and M. Chang declare that they have no competing interests.

Ethical standards

Ethics approval: the Institutional Review Board of the Affiliated Hospital of Northwest University approved this study (No. SYXSLL-2018-010), and the requirement for informed patient consent was waived due to the study’s retrospective nature. Informed consent: this was a retrospective study, hence, no informed consent is needed.

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Ye Tian and Mingze Chang contributed equally to this work.

Xiaobo Zhang and Nannan Han are co-first authors.

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Zhang, X., Han, N., Zhang, Y. et al. Predicting 3-month Functional Outcome After Endovascular Thrombectomy in Patients with Anterior Circulation Occlusion with an Arterial Transit Artifact Grading System. Clin Neuroradiol 34, 241–249 (2024). https://doi.org/10.1007/s00062-023-01362-3

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