Abstract Body: Background and Objective:. A stable perfusion pattern may guarantee a good clinical outcome in acute stroke patients. This study aimed to explore the differences of perfusion patterns over the acute phase in acute stroke patients with different etiologies.
Methods: This study included acute ischemic stroke patients who arrived at Huashan Hospital, Fudan University within 24 hours of last known normal. All patients underwent baseline multimodal CT scan (including CT angiography [CTA] and perfusion imaging), and had confirmed large vessel occlusion or severe stenosis of anterior circulation. Recanalization status was evaluated through follow-up perfusion or angiography imaging. Final infarct volume (FIV) was assessed by follow-up CT or magnetic resonance imaging within 7 days after arrival. Penumbral stability was assessed using the Perfusion-Infarct Index (PFI)，which was defined as 1 - (FIV - baseline infarct core) / baseline penumbra. For patients without recanalization, a stable penumbral pattern was defined PFI> 0.9. Kaplan-Meier survival curve analysis was used to explore the difference of PFI between patients with cardioembolic (CE) and large artery atherosclerotic (LAA) etiology during the acute phase. For patients without recanalization, stepwise logistic regression analysis was conducted to identify independent predictors of a stable penumbral pattern.
Results: A total of 250 acute ischemic stroke patients were included, with 160 classified as LAA-related stroke and 90 as CE-related stroke. Kaplan-Meier survival curve analysis revealed that LAA-related stroke patients had a higher PFI value compared to CE-related stroke patients throughout the acute phase (P=0.02). Of the 88 patients who did not achieve recanalization, patients with LAA-related stroke were more likely to have a stable penumbral pattern compared with patients with CE-related stroke (39% vs. 10.3%, P=0.01). Stepwise logistc regression analysis demonstrated that baseline NIHSS ≤8 (OR: 8.8, 95% CI: 2.9 - 26.4, P <0.001) and core growth rate ≤7 ml/h (OR: 9.7, 95% CI: 1.1 - 83.8, P =0.04) were independent predictors of a stable penumbral pattern.
Conclusion: Patients with LAA-related stroke are more likely to maintain a stable perfusion pattern through the acute phase compared to patients CE-related stroke. Baseline NIHSS ≤8 and core growth rate ≤7 ml/h were independent predictors of a stable penumbral pattern during the acute phase.