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

Abstract

Background: Although recanalization can be successful, microcirculatory dysfunction is common in acute large vessel occlusive stroke (LVOS). We assessed the microcirculation time by postprocessing software and analyzed its impact on prognosis in patients treated with mechanical thrombectomy (MT).

Methods: Patients with acute LVOS treated with MT were retrospectively enrolled consecutively. We measured the time to peak (TTP) and cerebral circulation time (CCT) in regions of interest on digital subtraction angiography using syngo iFlow software (Siemens Healthineers, Forchheim, Germany). A modified Rankin score ≤2 at 90 days was defined as a favorable outcome. Logistic regression was used to analyze the effect of each time parameter on prognosis. Then, we included time parameters in the baseline model to construct receiver operating characteristic (ROC) curves to assess the predictive ability for prognosis.

Results: A total of 215 patients were finally included. Of them, 118 (54.9%) had a favourable outcome at 90 days. Multivariate analysis showed that the microvascular cerebral circulation time (mCCT) was significantly associated with poor outcomes (odds ratio (OR) 2.061, 95% confidence interval (CI) 1.414 to 3.005 p<0.001). The area under the ROC curve was significantly enhanced by including mCCT in the baseline model (0.859 vs 0.829, p=0.016, DeLong test).

Conclusions: The mCCT immediately after recanalization is a powerful predictive factor for 90-day functional prognosis.

Keywords: Stroke; Thrombectomy.

Figure 1

Measurement of time to peak (TTP) and cerebral circulation time (CCT). (A) Regions of interest (ROIs) were set in color-coded images using syngo iFlow software (B) Time-density curve. CCT_C5-M4, cerebral circulation time from the vertical intracavernous portion of the internal carotid artery to the cortical segment of the rolandic artery; CCT_C5-VR, cerebral circulation time from the vertical intracavernous portion of the internal carotid artery to the rolandic vein; CCT_M4-VR, cerebral circulation time from the cortical segment of the rolandic artery to the rolandic vein; TTP_C5, time to peak of the vertical intracavernous portion of the internal carotid artery, TTP_M4, time to peak of the cortical segment of the rolandic artery; TTP_VR, time to peak of the rolandic vein.