MRA/DWI-ASPECTS Mismatch Predicts Early Neurological Deterioration In Acute Ischemic Stroke

Objective To analysis the risk factors for early neurologic deterioration(END)in patients with acute ischemic stroke(AIS)without reperfusion therapy.To explore the early predictive value of MRA/DWI-ASPECTS mismatch for early neurological deterioration in patients with ischemic stroke without reperfusion therapy,and to better guide clinical treatment.Methods Patients with first onset of acute ischemic stroke who were hospitalized in our hospital's Department of Neurology from March 2017 to February 2019 were continuously collected.The patient did not receive reperfusion therapy for a variety of reasons and had macroangiopathy diagnosed by cranial magnetic resonance angiography within 24 hours of onset.magnetic resonance angiography shows the degree of stenosis in the middle cerebral artery(MCA)and Alberta stroke program early CT score(ASPECTS)for abnormally high signal areas of diffusion weighted imaging(DWI),MRA/DWI-ASPECTS mismatch.The National Institutes of Health Stroke Scale(NIHSS)was used to assess the extent of neurological deficits.Detection of NIHSS at the time of admission and 72 hours of hospitalization.Early neurological deterioration was defined as the NIHSS score at admission 72 minus the NIHSS score at admission ? 2.According to the presence or absence of END,it is divided into END group and non-END group.Univariate analysis was used to compare baseline data,laboratory tests,imaging DWI-ASPECTS scores,and MRA/DWI-ASPECTS mismatch in the END and non-END groups.The P<0.2 variables in the univariate analysis were included in multivariate logistic regression analysis to analyze the correlation between MRA/DWI-ASPECTS mismatch and END.Results 1.A total of 103 patients with acute ischemic stroke who did not received reperfusion were collected in this study.There were 56 males(54.37%)and 47 females(45.63%);aged 35-86 years,with an average age of 67.01 ± 11.06 years.There were 17 cases(16.51%)in the END group,of which 10 cases(58.82%)had MRA / DWI-ASPECTS mismatch;86 cases(83.49%)in the non-END group,of which 24(27.91%)had MRA/DWI-ASPECTS mismatch.2.In the univariate baseline data study,there was a statistical difference in hypertension [11(64.71%)vs 33(38.37%),P = 0.045],diabetes [10(58.82%)vs 28(32.56%),P = 0.040],DWI-ASPECTS [8.00(6.00,8.00)vs 6.00(7.00.8.00),P = 0.010] and MRA/DWI-ASPECTS mismatch [10(58.82%)vs24(27.91%),P = 0.013]between the END group and the non-END group.The DWI-ASPECTS score was significantly lower in the END group than in the non-END group.Hypertension,diabetes,and MRA /DWI-ASPECTS mismatch are significantly higher in the END group than in the non-END group.3.The variables with P <0.2(age,hypertension,diabetes,fasting blood glucose,baseline NIHSS score,DWI-ASPECTS score,MRA/DWI-ASPECTS mismatch)in univariate analysis were included in the multivariate Logistic regression model.After adjusting for confounding factors,the results still suggest DWI-ASPECTS score(odds ratio=2.377,95% confidence interval:1.455?3.884,P=0.001)and MRA/DWI-ASPECTS mismatch(odds ratio=16.03,95% confidence interval:2.75 ? 93.62,P = 0.002)is independently related to the occurrence of early neurological deterioration in patients with anterior circulation acute ischemic stroke who did not receive reperfusion therapy,and is an independent predictor of it.After adjusting for confounding factors,the results still suggest DWI-ASPECTS score(odds ratio=2.377,95% confidence interval:1.455?3.884,P=0.001)and MRA/DWI-ASPECTS mismatch(odds ratio=16.03,95% confidence interval:2.75 ? 93.62,P = 0.002)is independently related to the occurrence of early neurological deterioration in patients with acute ischemic stroke who did not receive reperfusion therapy,and is an independent predictor of it.Conclusion 1.Hypertension,diabetes,DWI-ASPECTS,MRA/DWI-ASPECTS mismatch in clinical baseline materials are risk factors for early neurological deterioration in patients with acute ischemic stroke without reperfusion therapy.2.MRA/DWI-ASPECTS mismatch are independent predictors of early neurological deterioration in patients with acute ischemic stroke without reperfusion therapy.