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Association of FVH/DWI mismatch with recanalization after mechanical thrombectomy in acute anterior-circulation
Yuxia Gao1, Gege Yu1, Yongshi Teng1
1Department of Neurology District 1, Shennei Intensive Care Unit, Luoyang Central Hospital, Zhengzhou University, Luoyang, 471500, China.
Objective:
To investigate whether fluid-attenuated inversion recovery vascular hyperintensity/diffusion-weighted imaging (FVH/DWI) mismatch is associated with post-procedural recanalization in patients with acute anterior-circulation large-vessel occlusion (LVO) treated with mechanical thrombectomy.
Methods:
This retrospective cohort study enrolled 120 consecutive patients with acute anterior-circulation LVO who underwent mechanical thrombectomy at our hospital from March 2021 to June 2024. Clinical characteristics, imaging variables, and treatment-workflow data were collected. Based on angiographic reperfusion, patients were divided into a good recanalization group (modified Thrombolysis in Cerebral Infarction [mTICI] grade 2b-3; n = 82) and a poor recanalization group (mTICI grade 0-2a; n = 38). According to 90-day functional outcome assessed by the modified Rankin Scale (mRS), patients were further classified as having a favorable outcome (mRS 0-2; n = 74) or an unfavorable outcome (mRS 3-6; n = 46). Between-group differences were examined, and multivariable logistic regression was used to identify independent predictors of poor recanalization and unfavorable outcome.
Results:
The mean age in the good recanalization group was 66.81±9.10 years, which was significantly lower than that in the poor recanalization group (P < 0.05). FVH/DWI mismatch was more common in the good recanalization group (76.83%) than in the poor recanalization group (P < 0.05). Compared with patients with favorable outcomes, those with unfavorable outcomes were older (76.61±7.98 years), had higher admission National Institutes of Health Stroke Scale (NIHSS) scores (17.20±3.12), and exhibited a higher rate of poor recanalization (52.17%) (all P < 0.05), while the FVH/DWI mismatch rate was lower (28.26%, P < 0.05). Multivariable analysis showed that age (per 1-year increase: OR=1.089, 95%CI 1.032-1.149) and FVH/DWI mismatch (OR=0.523, 95%CI 0.312-0.876) were independent factors associated with poor recanalization (both P < 0.05). Age (per 1-year increase: OR=1.102, 95%CI 1.045-1.162), admission NIHSS score (per 1-point increase: OR=1.212, 95%CI 1.089-1.348), successful recanalization (OR=0.467, 95%CI 0.267-0.817), and FVH/DWI mismatch (OR=0.432, 95%CI 0.245-0.761) were independently associated with an unfavorable 90-day outcome (all P < 0.05).
Conclusion:
FVH/DWI mismatch is independently associated with both angiographic recanalization after mechanical thrombectomy and 90-day neurological outcomes in acute anterior-circulation LVO, and may serve as an imaging biomarker for predicting reperfusion success and clinical prognosis.
