PurposeOnly approximately half of anterior circulation large vessel occlusion (LVO) patients receiving endovascular treatment (EVT) have a favorable outcome. The aim of this study was to explore the association of dynamic inflammatory markers (i.e., neutrophil to lymphocyte ratios, NLR, measured at different times after EVT) as well as other potential influencing factors with unfavorable outcome among acute ischemic stroke (AIS) patients who achieved complete reperfusion after EVT.MethodsPatients treated with EVT for LVO between January 2019 to December 2021 were prospectively enrolled. Complete reperfusion was defined as modified thrombolysis in cerebral infarction (mTICI) grade 3. A modified Rankin scale at 90 days (mRS90) of 3–6 was defined as unfavorable outcome (i.e., futile reperfusion). A logistic regression analysis was performed with unfavorable outcome as a dependent variable. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were then used to determine the diagnostic values of NLR and other relevant factors.Results170 patients with complete reperfusion (mTICI 3) were included in this study. Unfavorable outcome was observed in 70 (41.2%). Higher NLR within 24h (p=0.017) and at 3-7d (p=0.008) after EVT were an independent risk factors for unfavorable outcome at 3 months. In addition, older age, higher NIHSS scores, poor collaterals, and general anesthesia were independent predictors of unfavorable outcomes. When accounting for NLR, the diagnostic efficiency improved compared to conventional characteristics.ConclusionOur findings suggest that advanced age, increased stroke severity, poor collaterals, general anesthesia, and NLR are independent predictors for an unfavorable clinical outcome following complete reperfusion after EVT. Neuroinflammation may merit particular attention in future studies.

Background: Multimodal CT imaging can evaluate cerebral hemodynamics and stroke etiology, playing an important role in predicting prognosis. This study aimed to summarize the comprehensive image characteristics of wake-up stroke (WUS), and to explore its value in prognostication.Methods: WUS patients with anterior circulation large vessel occlusion were recruited into this prospective study. According to the 90-day modified Rankin Scale (mRS), all patients were divided into good outcome (mRS 0–2) or bad (mRS 3–6). Baseline clinical information, multimodal CT imaging characteristics including NECT ASPECTS, clot burden score (CBS), collateral score, volume of penumbra and ischemic core on perfusion were compared. Multivariate logistic regression analysis was further used to analyze predictive factors for good prognosis. Area under curve (AUC) was calculated from the receiver operating characteristic (ROC) curve to assess prognostic value.Results: Forty WUS were analyzed in this study, with 20 (50%) achieving good outcome. Upon univariable analysis, the good outcome group demonstrated higher ASPECTS, higher CBS, higher rate of good collateral filling and lower penumbra volume when compared with the poor outcome group. Upon logistic regression analysis, poor outcome significantly correlated with penumbra volume (OR: 1.023, 95% CI = 1.003–1.043) and collateral score (OR: 0.140, 95% CI = 0.030–0.664). AUC was 0.715 for penumbra volume (95% CI, 0.550–0.846) and 0.825 for good collaterals (95% CI, 0.672–0.927) in predicting outcome.Conclusions:Penumbra volume and collateral score are the most relevant baseline imaging characters in predicting outcome of WUS patients. These imaging characteristics might be instructive to treatment selection. As the small sample size of current study, further studies with larger sample size are needed to confirm these observations.

Background: Accurate prediction of subsequent infarct volume in acute ischemic stroke (AIS) patients helps determine appropriate interventions and prognosis. The objectives are to assess whether early multimodal CT imaging characteristics of wake-up stroke (WUS) patients could predict post-reperfusion infarct volume and evaluate the accuracy of baseline infarct and penumbra volumes for predicting follow-up infarct volume.Methods: This retrospective study included WUS patients, last seen well (LSW) >6 hours, with multimodal CT imaging at baseline. Baseline non-contrast CT (NCCT) and CT perfusion were analyzed using RAPID software, and CT angiography using maximum intensity projection. Post-reperfusion infarct volume was assessed at 24-hour following reperfusion on magnetic resonance diffusion-weighted imaging (DWI).Patients were stratified by treatment module for analyses.Results: Of 34 eligible patients, 9 (26.5%) received intravenous recombinant tissue plasminogen activator (r-tPA) alone and 25 (73.5%) received both endovascular thrombectomy (EVT) and r-tPA. All patients had a strong correlation between baseline NCCT alberta stroke program early CT score, clot burden score (CBS), Tan score, infarct volume, penumbra volume with 24-hour post-reperfusion infarct volume (respectively, r=0.172, P=0.015; r=0.118, P=0.047; r=0.149, P=0.024; r=0.311, P=0.001 and r=0.120; P=0.045). Among reperfusion therapies, WUS patients who received EVT had a significantly lower 24-hour post-reperfusion infarct volume and had a significant difference between baseline infarct volume and 24-hour post-reperfusion infarct volume (respectively, 82 vs. 14, P=0.032 and 47 vs. 14, P=0.04).Conclusions: Primarily obtained multimodal CT imaging characteristics may predict post-reperfusion infarct volume in WUS patients, and those who underwent EVT had a significantly lower post-reperfusion infarct volume.

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