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Abstract：
UNASSIGNED: Identifying the underlying cause of acute middle cerebral artery occlusion (MCAO) as intracranial atherosclerotic stenosis (ICAS) or embolism is essential for determining the optimal treatment strategy before endovascular thrombectomy. We aimed to evaluate whether baseline computed tomography perfusion (CTP) characteristics could differentiate ICAS-related MCAO from embolic MCAO.
UNASSIGNED: We conducted a retrospective analysis of the clinical and baseline CTP data from patients who underwent endovascular thrombectomy for acute MCAO between January 2018 and December 2022. Core volume growth rate was defined as core volume on CTP divided by onset to CTP time. Multivariate logistic analysis was utilized to identify independent predictors for ICAS-related acute MCAO, and the diagnostic performance of these predictors was evaluated using receiver operating characteristic curve analysis.
UNASSIGNED: Among the 97 patients included (median age, 71 years; 60% male), 31 (32%) were diagnosed with ICAS-related MCAO, and 66 (68%) had embolism-related MCAO. The ICAS group was younger (p = 0.002), had a higher proportion of males (p = 0.04) and smokers (p = 0.001), a lower prevalence of atrial fibrillation (AF) (p < 0.001), lower NIHSS score at admission (p = 0.04), smaller core volume (p < 0.001), slower core volume growth rate (p < 0.001), and more frequent core located deep in the brain (p < 0.001) compared to the embolism group. Multivariate logistic analysis identified core volume growth rate (aOR 0.46, 95% CI 0.26-0.83, p = 0.01) as an independent predictor of ICAS-related MCAO. A cutoff value of 2.5 mL/h for core volume growth rate in predicting ICAS-related MCAO was determined from the receiver operating characteristic curve analysis, with a sensitivity of 81%, specificity of 80%, positive predictive value of 66%, and negative predictive value of 90%.
UNASSIGNED: Slow core volume growth rate identified on baseline CTP can predict ICAS-related MCAO. Further prospective studies are warranted to confirm and validate these findings.
UNASSIGNED: We conducted a retrospective analysis of the clinical and baseline CTP data from patients who underwent endovascular thrombectomy for acute MCAO between January 2018 and December 2022. Core volume growth rate was defined as core volume on CTP divided by onset to CTP time. Multivariate logistic analysis was utilized to identify independent predictors for ICAS-related acute MCAO, and the diagnostic performance of these predictors was evaluated using receiver operating characteristic curve analysis.
UNASSIGNED: Among the 97 patients included (median age, 71 years; 60% male), 31 (32%) were diagnosed with ICAS-related MCAO, and 66 (68%) had embolism-related MCAO. The ICAS group was younger (p = 0.002), had a higher proportion of males (p = 0.04) and smokers (p = 0.001), a lower prevalence of atrial fibrillation (AF) (p < 0.001), lower NIHSS score at admission (p = 0.04), smaller core volume (p < 0.001), slower core volume growth rate (p < 0.001), and more frequent core located deep in the brain (p < 0.001) compared to the embolism group. Multivariate logistic analysis identified core volume growth rate (aOR 0.46, 95% CI 0.26-0.83, p = 0.01) as an independent predictor of ICAS-related MCAO. A cutoff value of 2.5 mL/h for core volume growth rate in predicting ICAS-related MCAO was determined from the receiver operating characteristic curve analysis, with a sensitivity of 81%, specificity of 80%, positive predictive value of 66%, and negative predictive value of 90%.
UNASSIGNED: Slow core volume growth rate identified on baseline CTP can predict ICAS-related MCAO. Further prospective studies are warranted to confirm and validate these findings.
摘要：
■确定急性大脑中动脉闭塞（MCAO）的根本原因为颅内动脉粥样硬化性狭窄（ICAS）或栓塞对于确定血管内血栓切除术前的最佳治疗策略至关重要。我们旨在评估基线计算机断层扫描灌注（CTP）特征是否可以区分ICAS相关MCAO和栓塞MCAO。
■我们对2018年1月至2022年12月期间接受血管内血栓切除术治疗急性MCAO的患者的临床和基线CTP数据进行了回顾性分析。核心体积增长率定义为CTP上的核心体积除以开始到CTP时间。多因素分析用于确定ICAS相关急性MCAO的独立预测因子。并使用受试者工作特征曲线分析评估了这些预测因子的诊断性能。
■在包括的97名患者中（中位年龄，71岁；60%男性），31例（32%）被诊断为ICAS相关MCAO，66例(68%)患有栓塞相关MCAO。ICAS组较年轻（p=0.002），男性(p=0.04)和吸烟者(p=0.001)比例较高，房颤（AF）患病率较低（p<0.001），入院时NIHSS得分较低（p=0.04），更小的核心体积（p<0.001），较慢的核心体积增长率(p<0.001)，与栓塞组相比，更频繁的核心位于大脑深处（p<0.001）。多因素logistic分析确定核心体积增长率（aOR0.46，95％CI0.26-0.83，p=0.01）是ICAS相关MCAO的独立预测因子。从受试者工作特征曲线分析确定核心体积生长速率在预测ICAS相关MCAO时的截断值为2.5mL/h。灵敏度为81%,特异性为80%，阳性预测值为66%，阴性预测值为90%。
■在基线CTP上确定的缓慢的核心体积增长率可以预测与ICAS相关的MCAO。需要进一步的前瞻性研究来证实和验证这些发现。
■我们对2018年1月至2022年12月期间接受血管内血栓切除术治疗急性MCAO的患者的临床和基线CTP数据进行了回顾性分析。核心体积增长率定义为CTP上的核心体积除以开始到CTP时间。多因素分析用于确定ICAS相关急性MCAO的独立预测因子。并使用受试者工作特征曲线分析评估了这些预测因子的诊断性能。
■在包括的97名患者中（中位年龄，71岁；60%男性），31例（32%）被诊断为ICAS相关MCAO，66例(68%)患有栓塞相关MCAO。ICAS组较年轻（p=0.002），男性(p=0.04)和吸烟者(p=0.001)比例较高，房颤（AF）患病率较低（p<0.001），入院时NIHSS得分较低（p=0.04），更小的核心体积（p<0.001），较慢的核心体积增长率(p<0.001)，与栓塞组相比，更频繁的核心位于大脑深处（p<0.001）。多因素logistic分析确定核心体积增长率（aOR0.46，95％CI0.26-0.83，p=0.01）是ICAS相关MCAO的独立预测因子。从受试者工作特征曲线分析确定核心体积生长速率在预测ICAS相关MCAO时的截断值为2.5mL/h。灵敏度为81%,特异性为80%，阳性预测值为66%，阴性预测值为90%。
■在基线CTP上确定的缓慢的核心体积增长率可以预测与ICAS相关的MCAO。需要进一步的前瞻性研究来证实和验证这些发现。
