Abstract
IntroductionTo assess whether the asymmetrical cortical vessel sign (ACVS) on susceptibility‐weighted imaging (SWI) could predict 90‐day poor outcomes in anterior circulation acute ischemic stroke (AIS) patients treated with recombinant tissue plasminogen activator (r‐tPA).MethodsClinical data of consecutive patients with anterior circulation AIS treated with r‐tPA were retrospectively analyzed. Clinical variables included age, sex, vascular risk factors, NIHSS score, onset to treatment time, and initial hematologic and neuroimaging findings. Follow‐up was performed 90 days after onset. Poor outcome was defined as a modified Rankin scale (mRS) ≥3 at 90 days.ResultsA total of 145 patients were included, 35 (24.1%) patients presented with ACVS (≥Grade 1) on SWI. Fifty‐three (36.6%) patients had a poor outcome at 90 days. ACVS (≥Grade 1) occurred in 21 (39.6%) patients with poor outcome compared with 14 (15.2%) patients with favorable outcome (p = .001). Univariate analysis indicated that age, NIHSS score on admission, previous stroke, hemorrhagic transformation, severe intracranial large artery stenosis or occlusion (SILASO), and ACVS were associated with 90‐day poor outcome (p < .05). Since SILASO and ACVS were highly correlated and ACVS had different grades, we used three logistic regression models. Results from the three models showed that ACVS was associated with 90‐day poor outcome.ConclusionsIn r‐tPA‐treated patients with anterior circulation AIS, ACVS might be a helpful neuroimaging predictor for poor outcome at 90 days.
Highlights
To assess whether the asymmetrical cortical vessel sign (ACVS) on susceptibility-weighted imaging (SWI) could predict 90-day poor outcomes in anterior circulation acute ischemic stroke (AIS) patients treated with recombinant tissue plasminogen activator (r-tPA)
Age, National Institutes of Health Stroke Scale (NIHSS) score on admission (OR = 1.172, 95% CI = 1.073–1.280, p < .001), and ACVS (OR = 1.760, 95% CI = 1.191–2.601, p = .005) were significantly associated with 90-day poor outcome
Age (OR = 1.041, 95% CI = 1.005–1.079, p < .027), NIHSS score on admission (OR = 1.173, 95% CI = 1.074–1.281, p < .001), and Grade 3 ACVS (OR = 6.019, 95% CI = 1.436–25.237, p < .014) were significant predictors of 90-day poor outcome
Summary
Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (r-tPA) is an effective treatment for acute ischemic stroke (AIS) patients when administered within 4.5 hr of stroke onset (Hacke et al, 2008; The National Institute of Neurological Disorders & Stroke RT-PA Stroke Study Group, 1995). There is increasing evidence that indicates perfusion status in ischemic brain regions is related to outcomes in AIS patients after IVT (Bivard et al, 2015; Kawano et al, 2017; Kim, Kim, Oh, & Kim, 2004). The novel SWI-MRI marker asymmetrical cortical vessel sign (ACVS) has been associated with poor outcomes in anterior circulation AIS patients who had not undergone IVT therapy (Sun et al, 2014; Wang et al, 2018). We evaluated the effects of ACVS on clinical outcomes in anterior circulation AIS after IVT therapy
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