动脉内穿行伪影对急性前循环大血管闭塞性卒中行机械取栓血管成功再通患者预后的预测价值研究OA

Objective To develop a standardized arterial transit artifact(ATA)scoring system and evaluate its prognostic value for 90-day clinical outcomes in patients with anterior circulation large vessel occlusion(LVO)stroke undergoing mechanical thrombectomy,and to investigate the association between preoperative infarct volume and the ATA score.Methods Prospectively and consecutively included patients with acute anterior circulation LVO stroke who were admitted to the Department of Neurology of Songyuan Jilin Oilfield Hospital from January 2023 to December 2024,had an onset within 24 hours,underwent mechanical thrombectomy,and completed three dimensional-arterial spin labeling(3D-ASL)MR examination before the operation.All general and clinical data were collected,including sex,age,cerebrovascular risk factors(hypertension,diabetes mellitus,atrial fibrillation,smoking history,alcohol consumption,prior stroke history,hyperlipidemia,hyperhomocysteinemia),admission National Institutes of Health stroke scale(NIHSS)score,preoperative infarct volume,time from symptom onset to preoperative MR,site of the responsible occluded vessel(internal carotid artery or M1 segment of the middle cerebral artery),time from symptom onset to successful vessel recanalization,intravenous thrombolysis,and procedural variables(preferred endovascular approach[stent retriever alone,stent retriever combined with aspiration]),number of thrombectomy passes≤2,and rescue interventions(balloon angioplasty,stent placement,balloon angioplasty plus stent placement,or intra-arterial tirofiban infusion),time from femoral artery puncture to successful vessel recanalization.For patients within 4.5hours of onset and without contraindications to intravenous thrombolysis,intravenous thrombolysis with alteplase or tenecteplase was administered.Prior to bridging therapy following intravenous thrombolysis,a comprehensive brain MR was performed,including T1-weighted imaging,T2-weighted imaging,fluid-attenuated inversion recovery,diffusion-weighted imaging,MR angiography,and 3D-ASL.The middle cerebral artery perfusion territory was delineated according to the Alberta stroke program early CT score(ASPECTS)framework and divided into 7 anatomically defined regions(insular lobe,M1-M6 blood supplying area),for each region,the presence or absence of ATA signal within the cerebral sulci was assessed:a score of 1 was assigned if a distinct ATA signal was observed,and a score of 0 if no signal was detected.The total ATA score ranged from 0 to 7,with higher scores indicating more extensive distribution of ATA signals.The ATA scoring was conducted independently by two associate chief physicians from the MR department,each with over nine years of specialized experience in neuroimaging.Inter-rater agreement between the two raters was assessed using Cohen's Kappa coefficient,with the Kappa value interpreted as a measure of effect size.Agreement levels were defined as follows:Kappa value≥0.81,almost perfect;Kappa value 0.61-0.80,good;Kappa value 0.41-0.60,moderate;Kappa value 0.21-0.40,fair;and Kappa value≤0.20,slight.In cases of discordance,a third,senior chief physician from the same department provided the final decision.All patients were classified into two groups based on their 90-day modified Rankin scale(mRS)scores:a favorable outcome group(mRS score≤2)and an unfavorable outcome group(mRS score＞2).Variables exhibiting statistically significant differences between favorable outcome group and unfavorable outcome group were entered into a multivariate Logistic regression model,adjusted for potential confounders,to assess the association between preoperative ATA scores and 90-day favorable outcomes among anterior circulation LVO stroke patients undergoing mechanical thrombectomy and achieved successful recanalization.Receiver operating characteristic(ROC)curve analysis was performed to evaluate the predictive performance of preoperative ATA scores,as quantified by the area under the curve(AUC).Patients were subsequently stratified into low-ATA and high-ATA sub groups according to the optimal cutoff value determined by ROC analysis,and general and clinical characteristics were compared between two subgroups.The correlation between preoperative infarct volume and ATA scores was analyzed using Pearson or Spearman rank correlation,as with|r|≥0.8 indicating an extremely high correlation,and 0.6-＜0.8 indicating a high correlation,0.4-＜0.6 indicating a moderate correlation,0.2-＜0.4 indicating a weak correlation,and＜0.4 indicating an extremely weak correlation or no relation.Results A total of 81 patients with acute anterior circulation LVO who underwent mechanical thrombectomy and achieved successful recanalization were included,56male and25female patients,aged 38 to 81 years with a median age of 66(57,72)years.Of these,43 patients were assigned to the favorable outcome group and 38 patients to the unfavorable outcome group.(1)The ATA scores generated by two MR radiologists demonstrated a high degree of inter-rater agreement,with a Cohen's Kappa value of 0.811(95%CI 0.716-0.905,P＜0.01).(2)Significant differences were identified between the favorable outcome group and the unfavorable outcome group on hyperlipidemia,alcohol consumption,admission NIHSS score,ATA score,and infarot volume(all P＜0.05).(3)After adjustment for potential confounders,multivariate Logistic regression analysis showed that higher preoperative ATA score was an independent predictor of favorable 90-day outcomes in patients with acute anterior circulation LVO who underwent successful mechanical thrombectomy(OR,1.510,95%CI 1.111-2.051,P=0.008).(4)The optimal cutoff value of the preoperative ATA score for predicting 90-day outcomes in patients with anterior circulation LVO stroke who underwent successful mechanical thrombectomy was established at 3.5,with an AUC of 0.742(95%CI 0.635-0.890),sensitivity of 0.628,and specificity of 0.789.Based on this threshold,patients were categorized into the ATA low-score group(＜4 points;46 patients)and the ATA high-score group(≥4 points;35 patients).Comparative analysis demonstrated that the ATA high-score group had significantly lower admission NIHSS scores(12.00[10.50,14.00]scores vs.15.00[12.00,18.75]scores),smaller preoperative infarct volume(16.90[9.80,39.85]ml vs.36.15[17.38,96.85]ml)and a higher proportion of favorable outcomes(77.14%[27/35]vs.34.78%[16/46])than the ATA low-score group(all P＜0.01).(5)Spearman correlation analysis demonstrated a weak negative correlation between preoperative infarct volume and ATA score in acute anterior circulation LVO stroke patients who underwent successful mechanical thrombectomy(r=-0.359,P=0.001).Conclusions The preoperative ATA score was significantly associated with 90-day favorable outcomes in patients undergoing successful mechanical thrombectomy for acute anterior circulation LVO stroke,where higher ATA scores were indicative of a more favorable clinical prognosis.Furthermore,a weak negative correlation was observed between preoperative infarct volume and ATA score.