Diffusion- and Susceptibility Weighted Imaging Mismatch Correlates With Collateral Circulation and Prognosis After Middle Cerebral Artery M1-Segment Occlusion

Prominent Vessel Signs After Endovascular Thrombectomy Corelates with Unexplained Neurological Deterioration and is a More Reliable Imaging Predictor of Prognosis in Anterior Large Vessel Occlusion Stroke

OBJECTIVE

Fifty percent of patients who undergo endovascular thrombectomy (EVT) for large-vessel occlusion exhibit unfavorable outcomes. The primary factor is attributed to persistent brain impairment even after successful EVT. The prominent vessel sign (PVS) on magnetic resonance susceptibility-weighted imaging reflects the territory of dysmetabolism and may facilitate an expeditious assessment for prognostication. We aimed to examine the relationship between PVS after EVT and the occurrence of early neurological deterioration (END) and 3-month outcomes.

METHODS

Patients who underwent EVT and multimodal magnetic resonance imaging were included. END was defined as an increase of ≥2 in the National Institutes of Health Stroke Scale within 72 hours after EVT. Symptomatic intracranial hemorrhage, malignant edema, and surgical complications were defined as definite END, whereas the other symptoms were categorized as unexplained END (ux-END). The PVS-Alberta Stroke Program Early CT Score (ASPECTS) score was used to evaluate the asymmetric cerebral venous signal on the susceptibility-weighted imaging sequences semiquantitatively.

RESULTS

A total of 116 eligible patients were included, 18 (15.5%) of whom presented with ux-END. The 72 hour National Institutes of Health Stroke Scale was strongly correlated with diffusion-weighted imaging infarct volume and PVS-ASPECTS and was significantly higher in the ux-END group (16 ± 6 vs. 5 ± 4, P = 0.001). The PVS-ASPECTS score was significantly associated with poor outcomes (odds ratio 2.551, 95% confidence interval (CI) 1.722-3.780, P＜0.001), and PVS-ASPECTS (area under the curve 0.884, 95% CI 0.815-0.953, P < 0.001) was superior to diffusion-weighted imaging infarct volume (area under the cure 0.720, 95% CI 0.620-0.820, P = 0.001) in predicting 3-month poor outcome. At the optimal cut-off of 2, the PVS-ASPECT predicted poor outcomes with a sensitivity of 89.7% and a specificity of 78.2%.

CONCLUSIONS

PVS 72 hours after EVT correlated with ux-END. The PVS-ASPECTS is a more reliable predictor of stroke prognosis and provides valuable information regarding post-EVT management.

Changes of prominent vessel sign and susceptibility vessel sign in acute ischemic stroke patients with and without successful recanalization: a study based on susceptibility weighted images

OBJECTIVES

To investigate the changes of prominent vessel sign (PVS) and susceptibility vessel sign (SVS) in acute ischemic stroke (AIS) patients with successful and non-successful vascular recanalization treatment, and to study the associations between the susceptibility-weighted imaging (SWI) findings and early clinical and imaging prognosis.

METHODS

Thirty-five patients with the acute MCA territory infarction were retrospectively included and classified into Group_re (n = 25) and Group_non (n = 10) according to the success of vascular recanalization. NIHSS was used for clinical assessment. PVS and DWI were analyzed using ASPECT scores. Baseline, post-treatment, the changes of PVS and SVS, and SVS length were recorded and compared between two groups. Correlation analysis was performed between SWI factors and early post-treatment clinical and imaging factors.

RESULTS

The mean PVS_pre value was 5.20 ± 1.76 and PVS_post was 8.20 ± 1.86. PVS_pre and PVS_post showed statistical significance between Group_re and Group_non (both p < 0.001). A significant difference wasfound in SVS_post(+) (p < 0.001), SVS_post-pre(+) (p = 0.001), SVS_post-pre length (p = 0.036) and SVSpost length (p = 0.001) between the two groups.  A positive correlation was found between PVS_pre and DWI_post (p < 0.001, r = 0.564). There were positive correlations between PVS-DWI mismatch and NIHSS_post in Group_re (p = 0.042, r = 0.410) and in Group_non (p = 0.006, r = 0.789).

CONCLUSIONS

PVS and SVS changes are influenced by the success of vascular recanalization. However, the changes are unrelated to either early clinical or imaging outcomes in AIS patients. PVS-DWI mismatch can be taken as an imaging biomarker for early clinical outcomes, both for patients with or without successful vascular recanalization.