Prognostic value of Apparent Diffusion Coefficient for Mechanical Thrombectomy in Patients with Acute Posterior Ischemic Stroke

Abstract

BackgroundThis study investigates the prognostic value of the apparent diffusion coefficient (ADC) in MRI for patients with acute posterior circulation stroke (PCS) undergoing endovascular therapy (EVT). MethodsA retrospective analysis was conducted on patients with acute PCS from January 2017 to December 2021, confirmed by Diffusion Weighted Imaging (DWI)-ADC within 24 hours of onset. Patients were categorized based on their 3-month mRS score post-EVT. Data on NIHSS at admission, ADC value, and 3-month mRS were collected. Multivariable logistic regression analyzed the impact of various factors on ADC values. The receiver operating characteristic curve assessed predictive indices. ResultsAmong 94 patients, 47 had a good prognosis, and 47 had a poor prognosis. Univariate analysis revealed that factors significantly associated with a good prognosis included lower NIHSS at admission, higher ADC values, smaller infarct areas, unilateral infarction, basilar artery occlusion, lower PMT scores, intravenous thrombolysis, intra-arterial thrombolysis, and fewer perioperative complications (p < 0.05). Multivariable logistic regression identified high ADC values (p=0.002) and unilateral infarction (p=0.017) as independent predictive factors for prognosis. An ADC value > 549×10− 6 mm2/s was associated with a higher rate of good prognosis. Combining ADC values with unilateral infarction resulted in the highest AUC and Youden index of 0.766, with sensitivity and specificity of 89.36% and 87.23%, respectively (p<0.05). ConclusionHigh ADC values and unilateral infarction are independent predictive factors for the prognosis of PCS patients after EVT. Combining these factors provides the highest predictive accuracy, aiding in clinical decision-making for PCS treatment.