Frontiers in neurology · 2025
Assessment of cerebral hemodynamic changes in acute ischemic stroke patients following mechanical thrombectomy using CT perfusion imaging.
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Tian Chao, Chen Jing, Zhang Junfeng, Du Feizhou
Аннотация
BACKGROUND: Acute ischemic stroke (AIS) is a leading cause of disability and death in China, with mechanical thrombectomy (MT) being an effective treatment for AIS due to large vessel occlusion (LVO). The aim of this study was to evaluate the efficacy of MT in AIS patients using CT perfusion (CTP) imaging to assess cerebral hemodynamics before and after the procedure.
METHODS: This retrospective study enrolled 76 AIS patients with unilateral anterior circulation LVO (internal carotid artery or middle cerebral artery M1/M2 segments) who underwent MT at The General Hospital of Western Theater Command PLA from January 2020 to April 2023. All patients underwent pre- and post-thrombectomy CTP, with the interval between scans ≤72 h. Successful recanalization was defined as achieving modified Thrombolysis in Cerebral Infarction (mTICI) grade ≥2b (reperfusion of ≥50% of the ischemic territory) on immediate post-thrombectomy angiography. Primary outcomes included changes in perfusion abnormality range and CTP parameters [relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), relative mean transit time (rMTT), relative time to peak (rTTP), relative time to maximum of the residual function (rTmax)]. Secondary outcomes included 7-day NIHSS score improvement and 90-day modified Rankin Scale (mRS) scores.
RESULTS: Post-thrombectomy, 69 patients (90.8%) achieved successful recanalization (mTICI ≥ 2b), including 44 (57.9%) with mTICI 3 and 25 (32.9%) with mTICI 2b. CTP within 3 days post-MT showed significant increases in rCBF (0.560 ± 0.11 vs. 1.020 ± 0.29, P < 0.01) and rCBV (0.850 ± 0.13 vs. 1.010 ± 0.15, P < 0.01), and decreases in rMTT (1.41 vs. 1.03, P < 0.01), rTTP (1.380 ± 0.12 vs. 1.050 ± 0.12, P < 0.01), and rTmax (3.71 ± 0.1 vs. 1.40 ± 0.9, P < 0.01) compared to baseline. Perfusion abnormalities resolved in 36 patients (47.4%), reduced in 30 (39.5%), and showed no improvement in 10 (13.2%). Patients with resolved perfusion defects had higher rates of 7-day NIHSS improvement [89.7% vs. 60.7% (reduced) and 30.0% (no improvement), P = 0.001 and P = 0.011] and 90-day good outcomes (mRS 0-2: 83.3% vs. 33.3% and 20.0%, both P < 0.01). Hyperperfusion occurred in 15 (21.7%) successfully recanalized patients, with 73.3% achieving good 90-day outcomes.
CONCLUSION: CTP imaging is a valuable tool for assessing MT efficacy in AIS patients. Post-thrombectomy CTP detects significant improvements in cerebral hemodynamics, with resolved perfusion defects strongly predicting favorable clinical outcomes. These findings support the utility of CTP in monitoring post-treatment recovery and guiding clinical decision-making.
METHODS: This retrospective study enrolled 76 AIS patients with unilateral anterior circulation LVO (internal carotid artery or middle cerebral artery M1/M2 segments) who underwent MT at The General Hospital of Western Theater Command PLA from January 2020 to April 2023. All patients underwent pre- and post-thrombectomy CTP, with the interval between scans ≤72 h. Successful recanalization was defined as achieving modified Thrombolysis in Cerebral Infarction (mTICI) grade ≥2b (reperfusion of ≥50% of the ischemic territory) on immediate post-thrombectomy angiography. Primary outcomes included changes in perfusion abnormality range and CTP parameters [relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), relative mean transit time (rMTT), relative time to peak (rTTP), relative time to maximum of the residual function (rTmax)]. Secondary outcomes included 7-day NIHSS score improvement and 90-day modified Rankin Scale (mRS) scores.
RESULTS: Post-thrombectomy, 69 patients (90.8%) achieved successful recanalization (mTICI ≥ 2b), including 44 (57.9%) with mTICI 3 and 25 (32.9%) with mTICI 2b. CTP within 3 days post-MT showed significant increases in rCBF (0.560 ± 0.11 vs. 1.020 ± 0.29, P < 0.01) and rCBV (0.850 ± 0.13 vs. 1.010 ± 0.15, P < 0.01), and decreases in rMTT (1.41 vs. 1.03, P < 0.01), rTTP (1.380 ± 0.12 vs. 1.050 ± 0.12, P < 0.01), and rTmax (3.71 ± 0.1 vs. 1.40 ± 0.9, P < 0.01) compared to baseline. Perfusion abnormalities resolved in 36 patients (47.4%), reduced in 30 (39.5%), and showed no improvement in 10 (13.2%). Patients with resolved perfusion defects had higher rates of 7-day NIHSS improvement [89.7% vs. 60.7% (reduced) and 30.0% (no improvement), P = 0.001 and P = 0.011] and 90-day good outcomes (mRS 0-2: 83.3% vs. 33.3% and 20.0%, both P < 0.01). Hyperperfusion occurred in 15 (21.7%) successfully recanalized patients, with 73.3% achieving good 90-day outcomes.
CONCLUSION: CTP imaging is a valuable tool for assessing MT efficacy in AIS patients. Post-thrombectomy CTP detects significant improvements in cerebral hemodynamics, with resolved perfusion defects strongly predicting favorable clinical outcomes. These findings support the utility of CTP in monitoring post-treatment recovery and guiding clinical decision-making.