Abstract TP261: Red Blood Cell Distribution Width is Associated With Collateral Flow and Infarct Volume Growth in Acute Stroke With Large Artery Atherosclerosis

Abstract

Background and Purpose: Red cell distribution width (RDW) has been recognized as a prognostic marker in cardiovascular diseases and stroke. Increased RDW is predictive of poor outcome and mortality in acute ischemic stroke patients. However, the underlying mechanisms are not fully understood. We aimed to explore the association between RDW, collateral flow, infarct volume growth, final infarct volume (FIV), and clinical outcomes in acute stroke patients with large artery atherosclerosis. Methods: This is a single-center retrospective cohort study based on a prospective registry of consecutive acute ischemic stroke patients within 6 hours of onset. Acute ischemic stroke identified with anterior circulation large artery atherosclerosis (LAA) with complete baseline and follow-up imaging (Non-contrast CT, CT Angiography, Perfusion CT) as well as clinical profiles were enrolled. Collaterals was assessed using the volume ratio between delay time (DT) >3s and DT>6s lesions. Baseline infarct core volume was defined by relative cerebral blood flow<30%. FIV was calculated by manually drawing regions of interest on the follow-up images. Infarct volume growth was determined from FIV minus baseline infarct core volume. A good functional outcome was defined as a 3-month modified Rankin Score of 0-2. The relationship between RDW, collaterals, infarct volume growth, FIV and clinical outcomes were evaluated using multivariate models. Results: A total number of 100 patients were included in this study. Multivariate adjusted general linear models revealed that increased RDW was associated with poorer collaterals (multivariate adjusted coefficient -0.11, 95% CI -0.20 — -0.02, p=0.02) and increased infarct volume growth (multivariate adjusted coefficient 0.06, 95% CI 0.03 — 0.08, p<0.001). No significant relationship was found between RDW and FIV (multivariate adjusted coefficient 0.08, 95% CI -0.01 — 0.13, p=0.08), RDW and clinical outcomes (multivariate adjusted OR 1.66, 95% CI 0.44 — 6.28, p=0.46) probably due to the small sample size. Conclusion: For patients with LAA stroke, high RDW was associated with poorer collateral flow and increased infarct volume growth, which may explain the predictive value of RDW and poor functional outcomes in acute stroke.