Cerebral Circulation Time Is a Potential Predictor of Disabling Ischemic Cerebrovascular Events in Patients With Non-disabling Middle Cerebral Artery Stenosis

Abstract

Patients with non-disabling middle cerebral artery (MCA) stenosis (ND-MCAS) are at risk for disabling ischemic cerebrovascular events (DICE) despite aggressive medical therapy. In this study, we aimed to verify whether cerebral circulation time (CCT) was a potential predictor of DICE in patients with ND-MCAS. From January 2015 to January 2020, 46 patients with ND-MCAS treated with aggressive medical therapy were enrolled for digital subtraction angiography (DSA) in this convenience sampling study. They were divided into the DICE (–) and DICE (+) groups based on the occurrence of DICE within 3 months after DSA. The CCT was defined as the time from the appearance of the MCA to the peak intensity of the Trolard vein during DSA. The rCCT (relative CCT) was defined as the ratio of the CCT of the stenotic side (sCCT) to the CCT of the healthy side (hCCT). The differences in sCCT, hCCT, and rCCT between the two groups were analyzed with Mann-Whitney U tests. Logistic regression analysis was performed to evaluate the association between the risk factors and DICE. Receiver operating characteristic (ROC) curves were constructed to assess the predictive value of rCCT in identifying DICE in ND-MCAS patients. The results showed that DICE appeared in 5 of the 46 patients within 3 months. rCCT were significantly increased in the DICE (+) group compared with the DICE (–) group [1.08 (1.05, 1.14) vs. 1.30 (1.22, 1.54), p < 0.001]. Logistic regression analysis found that prolonged rCCT was an independent positive prognostic factor for DICE (odds ratio = 1.273, p = 0.019) after adjustment for potential confounders (age, diabetes, antithrombotic use, and stenosis degree). ROC analysis showed that rCCT provided satisfactory accuracy in distinguishing the DICE (+) group from the DICE (–) group among ND-MCAS patients (area under the curve = 0.985, p < 0.001), with an optimal cutoff point of 1.20 (100% sensitivity, 97.6% specificity). In conclusion, prolonged rCCT is independently associated with the occurrence of DICE in ND-MCAS patients and may be used to identify individuals at risk of DICE.

Sex Differences in Hemostatic Factors in Patients With Ischemic Stroke and the Relation With Migraine—A Systematic Review

“…However, it is yet unclear whether these factors could be used as predictors for stroke outcome ( Donkel et al, 2019 ). Also it is unknown whether they have additional value above other known prognostic factors in stroke ( Deng et al, 2018 ; Li et al, 2019 , 2020 ; Chang et al, 2021 ; Chen et al, 2021 ; Montellano et al, 2021 ). Female sex hormones can influence hemostatic factors causing the hemostasis system to function differently for men and women ( Abou-Ismail et al, 2020 ).…”

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

“…For example, (1) CCT was found to be correlated with prognosis for patients with subarachnoid hemorrhage: longer CCT predicted poorer outcome 24 ; (2) prolonged CCT is an independent prognostic factor for the occurrence of disabling ischemic cerebrovascular events in patients with symptomatic nondisabling middle cerebral artery stenosis. 17 Furthermore, Cronqvist et al found that CCT was more sensitive than the diffusible isotope technique for detecting the decreased flow associated with occlusive vascular disease. 40 …”

“…CCT based on ultrasound has been reported to be substantially prolonged in patients with multiple sclerosis or dementia, compared with controls. 15 , 16 CCT based on quantitative digital subtraction angiography (DSA) was found to be associated with the occurrence of disabling ischemic cerebrovascular events in patients who are not disabled, with symptomatic middle cerebral artery stenosis 17 and cerebral vasospasm in patients with subarachnoid hemorrhage. 18 Furthermore, cerebrovascular reserve as an independent risk factor for cerebral infarction 19 , 20 , 21 was found to be related to CCT derived from DSA.…”

Effect of prolonged microcirculation time after thrombectomy on the outcome of acute stroke

“…Cerebral circulation time (CCT) is confirmed to be an important parameter of cerebral blood flow reserve, which reflects the hemodynamic differences between symptomatic and asymptomatic carotid stenosis, hyperperfusion after carotid artery stenting and prediction of acute ischemic stroke in patients with middle cerebral artery stenosis. [1][2][3] It was first proposed by Greitz to be calculated on digital subtraction angiography (DSA) by measuring the time interval from visualization of the intracranial arteries to clouding of the cortical veins. 4 However, CCT lacks a unified evaluation method.…”