Dynamic changes and associated factors of asymmetric prominent vessel sign in atherosclerotic anterior circulation acute ischemic stroke: a preliminary study.

OBJECTIVE

To investigate the dynamic changes, influencing factors, and prognostic significance of the asymmetric prominent vessel sign (APVS) in patients with atherosclerotic anterior circulation acute ischemic stroke (AIS).

METHODS

Patients with atherosclerotic anterior circulation AIS who were admitted within 48 h after symptom onset and had complete baseline and follow-up diffusion-weighted imaging (DWI) and susceptibility-weighted imaging (SWI) data obtained 10-14 days after treatment were retrospectively enrolled. Changes in APVS were evaluated. Clinical and imaging data were collected, including the degree of vascular stenosis, baseline SWI-DWI mismatch, NIHSS scores before and after treatment, infarct volume, SWI-Alberta Stroke Program Early CT Score (SWI-ASPECTS), early neurological deterioration (END) within 7 days, and 90-day mRS scores. According to the difference in SWI-ASPECTS scores before and after treatment, patients were categorized into the significant APVS change group (≥2 points) and the non-significant APVS change group (0-1 point). Univariate analyses were performed to preliminarily explore the factors associated with APVS changes and the relationship between APVS changes and clinical outcomes.

RESULTS

A total of 34 patients were included, among whom 11 were assigned to the significant APVS change group. After 10-14 days of standardized conservative medical treatment, the APVS extent remained unchanged in 38.2% of patients, decreased to varying degrees in 58.8% (including complete disappearance in 17.6%), and increased in only 2.9% of patients. Univariate analysis demonstrated that patients in the significant change group had larger baseline infarct volumes (T = -2.191, p = 0.028) and post-treatment infarct volumes (T = -2.779, p = 0.005), a higher proportion of severe vascular stenosis (p = 0.009), and higher baseline SWI-ASPECTS scores (T = -3.117, p = 0.002). No statistically significant differences were observed in the incidence of END or 90-day mRS scores between the two groups.

CONCLUSION

Following standardized treatment for 10-14 days, APVS extent decreased or even disappeared in most patients, whereas persistent APVS was observed in a subset of patients. Baseline and post-treatment infarct volumes, degree of vascular stenosis, and baseline SWI-ASPECTS scores may influence APVS evolution. However, APVS changes were not significantly associated with clinical prognosis.