Cerebral Circulation Time After Thrombectomy: A Potential Predictor of Outcome After Recanalization in Acute Stroke

Abstract

Background Despite successful recanalization, up to half of patients with acute ischemic stroke caused by large‐vessel occlusion treated with endovascular treatment (EVT) do not recover to functional independence. We aim to evaluate the role of cerebral circulation time (CCT) as outcome predictor after EVT. Methods and Results We retrospectively enrolled consecutive patients with acute ischemic stroke–large‐vessel occlusion undergoing EVT. Three categories of CCT based on digital subtraction angiography were studied: CCT of the stroke side, CCT of the healthy side), and change of CCT of the stroke side versus CCT of the healthy side. Dramatic clinical recovery was defined as a 24‐hour National Institutes of Health Stroke Scale score ≤2 or ≥8 points drop. A modified Rankin Scale score ≤2 at 3 months was considered a favorable outcome. Logistic regression analysis was performed to evaluate the prediction of CCT on prognosis. One hundred patients were enrolled, of which 38 (38.0%) experienced a dramatic clinical recovery and 43 (43.0%) achieved a favorable outcome. Logistic regression analysis found that shorter change of CCT of the stroke side versus CCT of the healthy side and CCT of the stroke side were independent positive prognostic factors for dramatic clinical recovery (odds ratio [OR], 0.189; P =0.033; OR, 0.581; P =0.035) and favorable outcomes (OR, 0.142; P =0.020; OR, 0.581; P =0.046) after adjustment for potential confounders. A model including the change of CCT of the stroke side versus CCT of the healthy side also had significantly higher area under the curve values compared with the baseline model in patients with dramatic clinical recovery (0.780 versus 0.742) or favorable outcome (0.759 versus 0.713). Conclusions To our knowledge, this is the first report that CCT based on digital subtraction angiography data exhibits an independent predictive performance for clinical outcome in patients with acute ischemic stroke–large‐vessel occlusion after EVT. Given that this readily available CCT can provide alternative perfusion information during EVT, a prospective, multicenter trial is warranted.

Association between collaterals, cerebral circulation time and outcome after thrombectomy of stroke

“…After excluding 58 patients with posterior circulation stroke, 45 patients without successful recanalization, 18 patients who received intraarterial thrombolysis, 4 patients with incomplete DSA images, 3 patients with incomplete clinical data and 2 patients with mRS ≥ 2 before onset, 100 patients were included in the final analysis. 11 Overall, 26 patients (26.0%) were in the good collateral group and 74 patients (74.0%) in the poor collateral group. A total of 43 patients (43.0%) had favorable functional outcome at 90 days (mRS score 0-2).…”

“…From May 2019 to May 2021, 230 consecutive patients were enrolled in our study. After excluding 58 patients with posterior circulation stroke, 45 patients without successful recanalization, 18 patients who received intra‐arterial thrombolysis, 4 patients with incomplete DSA images, 3 patients with incomplete clinical data and 2 patients with mRS ≥ 2 before onset, 100 patients were included in the final analysis 11 …”

“…Previous studies have shown that good collateral circulation may help reduce cerebral circulation time (CCT) in some patients with high‐grade carotid artery stenosis, 10 which may be related to the fact that the presence of good collateral status is associated with a higher degree of stenosis. Our recent study found that for patients with successful reperfusion, CCT and collateral status based on DSA data were highly correlated with functional outcomes 11 . In this context, we hypothesize that change in CCT may be one of the mechanisms by which CS improves outcomes.…”

“…Patient informed consent was waived given the retrospective nature of the analysis and minimal risk to subjects. We used the same AIS‐LVO patient cohort, which has been reported in detail in our recent study 11 . Briefly, we enrolled all unilateral, anterior circulation AIS‐LVO consecutive patients who were treated with EVT and achieved successful reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) score of 2b‐3) from May 2019 to May 2021 at the General Hospital of the Northern Theater Command.…”

“…In our stroke center, the EVT protocol has been recently described in detail 11 . Briefly, a stroke patient with a highly suspected LVO was directly transferred to the angiographic suite without additional CTA or/and CTP after head Computed Tomography was performed.…”