Abstract 3299: Can The Perfusion Status Predict The Subsequent Ischemic Events Following Acute Symptomatic Steno-occlusion Of Cerebral Arteries?
Background: Symptomatic steno-occlusion (SYSO) is associated with stroke progression and recurrence after acute ischemic stroke. And the perfusion status is believed to be an important determinant in this situation. However, the impact of perfusion status on progression or recurrence has not been studied yet in patients with acute SYSO.
Method: Based on prospective stroke registry, a consecutive series of 1309 patients were identified who were hospitalized due to ischemic stroke within 24 hours of onset. Among them, we selected who had more than 50% of stenosis or occlusion of extracranial internal carotid artery (EICA), intracranial internal carotid artery (IICA), middle cerebral artery (M1 and M2), anterior cerebral artery (ACA), and posterior cerebral artery (PCA) with the corresponding ischemic lesions. Patients who did not undergo perfusion study, who had infratentorial stroke, or the quality of whose perfusion image was poor were excluded. The perfusion status was assessed by perfusion lesion volume (PLV) using geometric method of visually delineated area. Stroke progression and recurrence (subsequent ischemic event, SIE) were defined and captured prospectively up to 1 year as a part of the institution’s quality-of-care monitoring program for hospitalized stroke patients.
Result: A total 385 patients (age: 69.7 ± 12.6 year-old) were enrolled in this study. The distribution of PLV according to the location of SYSO was presented in the figure below. A total 88 patients (22.9%) experienced SIE and 72.7% were ischemic progression. The SIE rates of EICA, IICA, M1, M2, ACA and PCA were 31.8%, 24.1%, 19.9%, 14.1%, 15.4% and 25.0%, respectively. The PLV was dichotomized at median value of each SYSO location and the SIE rate was 26.6% in patients with high PLV and 19.2% in those with low PLV (P=0.084). The SIE rate of patients with occlusion (N=282) was not different from those with stenosis (N=103) (P=0.672). In the multivariable model, the adjusted odds ratio of PLV was 1.64 (95% confidence interval, 0.98-2.74) for the risk of SIE. The adjustments were done for male, time from onset to admission, baseline NIHSS score, and thrombolysis. After additional adjustment for recanalization status, the odds ratio of PLV was 1.81 (1.06 to 3.08).
Conclusion: This study shows that the initial perfusion status may predict the following stroke progression or recurrence in patients with acute symptomatic steno-occlusion of cerebral arteries.
- © 2012 by American Heart Association, Inc.