Tmax volume can predict clinical type in patients with acute ischemic stroke

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Endovascular therapy (EVT) is a critical treatment for acute ischemic stroke (AIS) with large vessel occlusion (LVO).
• Clinical outcomes and treatment strategies for AIS-LVO vary significantly based on the underlying cause, specifically cardiac embolism (CE) versus intracranial arteriosclerosis-derived LVO (ICAS-LVO).
• Accurate pre-treatment classification is essential for optimizing patient management.

Purpose of the Study:

• To investigate whether time-to-maximum (Tmax) volume, derived from perfusion imaging, can predict the clinical classification of AIS patients with LVO prior to EVT.
• To determine if Tmax volume can differentiate between CE and ICAS-LVO etiologies.

Main Methods:

• Retrospective analysis of consecutive AIS patients with anterior circulation LVO who underwent automated imaging software evaluation.
• Patients were categorized into CE and ICAS-LVO groups.
• Comparison of imaging parameters, including Tmax volumes, between the two groups using statistical analysis.

Main Results:

• Thirty-nine patients were included in the study.
• Significantly greater Tmax volume, Tmax > 6s volume, and Tmax > 6s/Tmax > 4s volume ratios were observed in the CE group compared to the ICAS-LVO group.
• Multiple logistic regression revealed a significant association between clinical classification and elevated Tmax > 6s/Tmax > 4s volume ratios (p=0.04).

Conclusions:

• Tmax volume derived from perfusion imaging serves as a valuable predictor for classifying AIS patients before EVT.
• This imaging parameter can aid in distinguishing between cardiac embolism and intracranial arteriosclerosis as the cause of LVO.
• The findings support the use of Tmax volume in pre-procedural stroke assessment to guide treatment decisions.