Correlation Study Of Multi-phase CTA Collateral Circulation Score And CTP Parameters With Clinical Prognosis In Patients With Acute Ischemic Stroke

Part1 Comparative Study of Multi-phase CTA Collateral Circulation Score Based on FastStroke Software with DSA and CTP Parameters in Patients with Acute Ischemic StrokeObjective:To explore the clinical reliability of multi-phase CT angiography(mCTA)collateral circulation score based on FastStroke software in evaluating the collateral circulation of patients with acute ischemic stroke(AIS).At the same time,to explore the correlation between the collateral status based on FastStroke and CT perfusion(CTP)parameters.Materials and Methods:A retrospective analysis of 74 patients with anterior circulation acute ischemic stroke were performed.All enrolled patients were treated with thrombectomy.One-stop CT examination and digital subtraction angiography(DSA)were performed before treatment.The inclusion criteria for AIS patients:(1)onset time less than 24 h;(2)unilateral middle cerebral artery(MCA)and/or ICA or anterior cerebral artery(ACA)severe stenosis or occlusion on CTA;(3)DSA examination and thrombectomy were performed.The original images of mCTA were post-processed by FastStroke software,and CTP was post-processed by Mistar software.Spearman correlation analysis was used to evaluate the correlation between collateral circulation score based on FastStroke and DSA collateral circulation score and the correlation with CTP perfusion parameters.Results:The weighted kappa coefficients of the consistency test of mCTA collateral circulation score based on FastStroke and DSA collateral circulation score were 0.729(95%CI:0.615-0.843)and 0.837(95%CI:0.752-0.923)respectively.The mCTA collateral circulation score based on FastStroke had a strong correlation with the DSA collateral circulation score(r=0.716,P<0.001).In patients with different FastStroke collateral status,the core infarct volume defined by relative cerebral blood flow(rCBF)<30%and mismatch ratio were significantly different(P<0.05).The core infarct volume rCBF<30%was inversely related to collateral status based on FastStroke(r=-0.532,P<0.001),but the mismatch ratio was positively correlated with the collateral status based on FastStroke(r=0.508,P<0.001).Conclusion:The mCTA collateral circulation scoring method based on FastStroke software can be used as a reliable and fast collateral circulation scoring method.The core infarct volume rCBF<30%and mismatch ratio can indirectly reflect the degree of collateral circulation in patients with acute ischemic stroke.Part 2 Study of the predictive value of different collateral circulation scores and CIP parameters in the clinical prognosis of patients with Acute Ischemic StrokeObjective:To analyze the predictive factors of the clinical prognosis of AIS patients after thrombectomy treatment,and compare the predictive value of different collateral circulation scores and CTP parameters for the 3-month clinical prognosis of AIS patients.Materials and Methods:A retrospective analysis of 70 patients with anterior circulation acute ischemic stroke were performed.All enrolled patients underwent a onestop CT examination before thrombectomy treatment.The original images of mCTA were post-processed by FastStroke software and scored for collateral circulation.CTP images was post-processed by Mistar software.The independent sample t test and Kruskal-Wallis test were used to compare the differences in clinical baseline and imaging parameters between the good prognosis and the poor prognosis group,and variables with statistical significant(P<0.05)were included in the binary logistic regression model.Binary logistic regression was used to analyze independent predictors of clinical prognosis in AIS patients after thrombectomy.The receiver operating characteristic(ROC)curve was used to analyze the predictive power of each parameter.Results:The admission NIHSS score,sCTA,mCTA,FastStroke collateral circulation score,infarct core volume and mismatch ratio were statistically significant between the good prognosis and the poor prognosis group(P<0.05).The ROC curve results showed that the predictive efficacy of the admission NIHSS score,sCTA,mCTA,FastStroke collateral circulation score,core infarct volume,and mismatch ratio on the clinical prognosis of AIS patients after thrombectomy was 0.727,0.639,0.701,0.659,0.688,0.703,respectively,but there was no statistical difference in predictive power AUC(De-long test:P>0.05).The binary logistic regression results showed that the admission NIHSS score and mCTA collateral circulation score were independent predictors of the clinical prognosis of AIS patients after thrombectomy(OR:0.867,95%CI:0.766-0.983;OR:5.138,95%CI:1.09924.017).The predictive power of the admission NIHSS score combined with mCTA collateral circulation score was AUC=0.771,the sensitivity was 85.0%,and the specificity was 63.33%.The combined predictive power of the NIHSS score and mCTA collateral circulation score was better than that of the admission NIHSS score and mCTA collateral circulation score.However,there was no statistical difference between the AUC of the admission NIHSS score combined with mCTA collateral circulation score and the AUC of the admission NIHSS score(De-long test:P=0.36),and there was a statistical difference between the AUC of mCTA collateral circulation score(De-long test:P=0.03).Conclusion:The admission NIHSS score and mCTA collateral circulation score are independent predictors of the clinical prognosis of AIS patients after 3 months of thrombectomy treatment,and the combination of the admission NIHSS score and mCTA collateral circulation score can improve the predictive value of mCTA collateral circulation score for the clinical prognosis of AIS patients,which has certain guiding significance for the thrombectomy treatment in AIS patients.