Abstract
BackgroundEndovascular therapy is widely used in acute large vessel occlusion. This study investigated whether imaging of lateral lenticulostriate arteries (LSAs) before thrombectomy would potentially be helpful for predicting prognosis of patients with acute M1 segment of middle cerebral artery occlusion (MCAO).Methods59 consecutive patients with acute M1 segment of MCAO treated with mechanical thrombectomy at two comprehensive stroke centers were analyzed. Patients were categorized into LSA+ (appearing of lateral LSAs) and LSA- (sparing of lateral LSAs) group according to preprocedural digital substraction angiography (DSA). Baseline data and clinical outcomes were compared. A good clinical outcome was defined as a modified Rankin Scale score of 0 to 2 at 3 months. The association between clinical and imaging parameters and functional outcome was evaluated with logistic regression analysis.ResultsLSA+ was shown in 36 patients (61%). LSA+ group had a significantly higher proportion of good outcome (72.2% vs. 8.7%, OR 27.3,95% CI 5.38–138.4, P < 0.001), lower risk of symptomatic intracranial haemorrhages (sICH) (8.3% vs. 47.8%,OR 0.10,95% CI 0.02–0.42, P = 0.001) and lower mortality in hospital (5.6% vs. 34.8%, OR 0.11,95% CI 0.02–0.58, P < 0.004) compared with LSA- group. Patients in LSA+ group had lower baseline NIHSS score(P < 0.01) and NIHSS score at 14 days(P < 0.01) and smaller infarct core volume (P = 0.016) on computed tomography perfusion imaging (CTP) compared to the LSA- group. Multivariate logistic regression analysis showed that a small infarct core volume (OR 6.74,95% CI 1.148–39.569, P = 0.035) and LSA+(OR 22.114,95% CI 3.339–146.470, P = 0.001) were associated with a good clinical outcome.ConclusionsOur data suggest that appearance of lateral LSAs before mechanical thrombectomy would be potentially helpful for predicting favorable prognosis of patients with acute M1 segment of MCAO.
Highlights
Endovascular therapy is widely used in acute large vessel occlusion
The area supplied by lateral lenticulostriate arteries (LSAs) lacking of collateral vessels may play a unique role in acute middle cerebral artery occlusion (MCAO) independent of time and collateral flow
Among the leaving 59 patients, the mean age was 69.8 ± 11.2 years, 40 patients (67.8%) were female, and the median baseline National Institute of Health Stroke Scale (NIHSS) was 15. 25 patients (42.4%) received intravenous thrombolysis treatment before thrombectomy (31 patients with contraindications and 3 failed to obtain consents which was officially acquired in China) and the mean door-to needle time (DNT) was 51 min
Summary
Endovascular therapy is widely used in acute large vessel occlusion. This study investigated whether imaging of lateral lenticulostriate arteries (LSAs) before thrombectomy would potentially be helpful for predicting prognosis of patients with acute M1 segment of middle cerebral artery occlusion (MCAO). In addition to the time to treatment, infarct core volume, penumbra and collateral circulation, more concise imaging parameters are worth exploring [7,8,9]. The area supplied by lateral lenticulostriate arteries (LSAs) lacking of collateral vessels may play a unique role in acute middle cerebral artery occlusion (MCAO) independent of time and collateral flow. The objective of this study was to investigate whether the lateral LSAs observed before thrombectomy could predict good clinical outcomes
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