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. 2020 Jul;10(7):e01657.
doi: 10.1002/brb3.1657. Epub 2020 May 20.

Asymmetrical cortical vessel sign predicts prognosis after acute ischemic stroke

Yong-Lin Liu  1 , Wei-Min Xiao  1 , Jie-Kai Lu  1 , Ya-Zhi Wang  1 , Zhi-Hao Lu  1 , Huo-Hua Zhong  1 , Jian-Feng Qu  1 , Xue-Wen Fang  2 , Man-Qiu Liang  2 , Yang-Kun Chen  1
Affiliations

Asymmetrical cortical vessel sign predicts prognosis after acute ischemic stroke

Yong-Lin Liu et al. Brain Behav. 2020 Jul.

Abstract

Introduction: To assess whether the asymmetrical cortical vessel sign (ACVS) on susceptibility-weighted imaging (SWI) could predict 90-day poor outcomes in anterior circulation acute ischemic stroke (AIS) patients treated with recombinant tissue plasminogen activator (r-tPA).

Methods: Clinical data of consecutive patients with anterior circulation AIS treated with r-tPA were retrospectively analyzed. Clinical variables included age, sex, vascular risk factors, NIHSS score, onset to treatment time, and initial hematologic and neuroimaging findings. Follow-up was performed 90 days after onset. Poor outcome was defined as a modified Rankin scale (mRS) ≥3 at 90 days.

Results: A total of 145 patients were included, 35 (24.1%) patients presented with ACVS (≥Grade 1) on SWI. Fifty-three (36.6%) patients had a poor outcome at 90 days. ACVS (≥Grade 1) occurred in 21 (39.6%) patients with poor outcome compared with 14 (15.2%) patients with favorable outcome (p = .001). Univariate analysis indicated that age, NIHSS score on admission, previous stroke, hemorrhagic transformation, severe intracranial large artery stenosis or occlusion (SILASO), and ACVS were associated with 90-day poor outcome (p < .05). Since SILASO and ACVS were highly correlated and ACVS had different grades, we used three logistic regression models. Results from the three models showed that ACVS was associated with 90-day poor outcome.

Conclusions: In r-tPA-treated patients with anterior circulation AIS, ACVS might be a helpful neuroimaging predictor for poor outcome at 90 days.

Keywords: acute ischemic stroke; asymmetrical cortical vessel sign; intravenous thrombolysis; outcome; susceptibility-weighted imaging.

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Conflict of interest statement

None declared.

Figures

FIGURE 1
FIGURE 1
Flowchart of the selection process. AIS, acute ischemic stroke; DWI, diffusion‐weighted imaging; IVT, intravenous thrombolysis; MRI, magnetic resonance imaging; mRS, modified Rankin scale; and SWI, susceptibility‐weighted imaging
FIGURE 2
FIGURE 2
A 60‐year‐old male patient with a history of hypertension and diabetes for 5 years was admitted for AIS 3 hr after onset. He had aphasia, right hemiplegia, and an NIHSS score of 11 on admission. He was treated with IVT 4 hr after onset. An MRI scan was performed 24 hr after onset. DWI showed multi‐focal acute infarcts in the left MCA territory (a); MRA showed occlusion of the left MCA in the M1 segment (b); and SWI showed more and larger vessels with signal loss, indicating ACVS (Grade 3, white arrow) in the left MCA territory (c). His mRS was 4 at 90 days after onset, and the patient remained dependent
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References

    1. Adams Jr, H. P. , Bendixen, B. H. , Kappelle, L. J. , Biller, J. , Love, B. B. , Gordon, D. L. , & Marsh 3rd, E. E. (1993). Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke, 24, 35–41. 10.1161/01.str.24.1.35 - DOI - PubMed
    1. Adams, H. P. , Davis, P. H. , Leira, E. C. , Chang, K. C. , Bendixen, B. H. , Clarke, W. R. , … Hansen, M. D. (1999). Baseline NIH Stroke Scale score strongly predicts outcome after stroke: A report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST). Neurology, 53, 126–131. 10.1212/wnl.53.1.126 - DOI - PubMed
    1. An, H. , & Lin, W. (2000). Quantitative measurements of cerebral blood oxygen saturation using magnetic resonance imaging. Journal of Cerebral Blood Flow and Metabolism, 20, 1225–1236. 10.1097/00004647-200008000-00008 - DOI - PMC - PubMed
    1. Baik, S. K. , Choi, W. , Oh, S. J. , Park, K. P. , Park, M. G. , Yang, T. I. , & Jeong, H. W. (2012). Change in cortical vessel signs on susceptibility‐weighted images after full recanalization in hyperacute ischemic stroke. Cerebrovascular Disease, 34, 206–212. 10.1159/000342148 - DOI - PubMed
    1. Bivard, A. , Levi, C. , Krishnamurthy, V. , McElduff, P. , Miteff, F. , Spratt, N. J. , … Parsons, M. (2015). Perfusion computed tomography to assist decision making for stroke thrombolysis. Brain, 138, 1919–1931. 10.1093/brain/awv071 - DOI - PMC - PubMed

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