Abstract
Background and Purpose: Acute ischemic stroke of the anterior circulation due to large vessel occlusion (LVO) is a multifactorial process, which causes neurologic symptoms of different degree. Our aim was to examine the impact of neuromorphologic and vascular correlates as well as clinical factors on acute symptom severity in LVO stroke.Methods: We selected LVO stroke patients with known onset time from a consecutive cohort which underwent multiparametric CT including non-contrast CT, CT angiography and CT perfusion (CTP) before thrombectomy. Software-based quantification was used to calculate CTP total ischemic and ischemic core volume. Symptom severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) upon admission. Multivariable regression analysis was performed to determine independent associations of admission NIHSS with imaging and clinical parameters. Receiver operating characteristics (ROC) analyses were used to examine performance of imaging parameters to classify symptom severity.Results: We included 142 patients. Linear and ordinal regression analyses for NIHSS and NIHSS severity groups identified significant associations for total ischemic volume [β = 0.31, p = 0.01; Odds ratio (OR) = 1.11, 95%-confidence-interval (CI): 1.02–1.19], clot burden score (β = −0.28, p = 0.01; OR = 0.76, 95%-CI: 0.64–0.90) and age (β = 0.17, p = 0.04). No association was found for ischemic core volume, stroke side, collaterals and time from onset. Stroke topography according to the Alberta Stroke Program CT Score template did not display significant influence after correction for multiple comparisons. AUC for classification of the NIHSS threshold ≥6 by total ischemic volume was 0.81 (p < 0.001).Conclusions: We determined total ischemic volume, clot burden and age as relevant drivers for baseline NIHSS in acute LVO stroke. This suggests that not only mere volume but also degree of occlusion influences symptom severity. Use of imaging parameters as surrogate for baseline NIHSS reached limited performance underlining the need for combined clinical and imaging assessment in acute stroke management.
Highlights
Multiparametric CT imaging raises the opportunity to comprehensively assess cerebrovascular status in large vessel occlusion (LVO) stroke, including tissue perfusion, topography, collateral flow, thrombus burden or edema formation
While imaging based parameters and baseline National Institutes of Health Stroke Scale (NIHSS) were extensively studied regarding their impact on chronic outcome after stroke, the interplay of neuromorphologic and vascular stroke correlates with acute symptom severity remains largely unexplored [8,9,10,11]
Patients with acute ischemic stroke due to anterior circulation large vessel occlusion were selected out of a consecutive cohort of 653 patients between 2015 and 2020, who were prospectively enrolled in the German Stroke Registry and treated with endovascular therapy (EVT) at our institution
Summary
Multiparametric CT imaging raises the opportunity to comprehensively assess cerebrovascular status in large vessel occlusion (LVO) stroke, including tissue perfusion, topography, collateral flow, thrombus burden or edema formation. These parameters directly translate to morphologic correlates of stroke e.g., penumbra and core volume as well as the temporal course of infarction growth [1,2,3,4,5]. While imaging based parameters and baseline NIHSS were extensively studied regarding their impact on chronic outcome after stroke, the interplay of neuromorphologic and vascular stroke correlates with acute symptom severity remains largely unexplored [8,9,10,11]. Our aim was to examine the impact of neuromorphologic and vascular correlates as well as clinical factors on acute symptom severity in LVO stroke
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