TY - JOUR
T1 - Larger Perfusion Mismatch Volume Is Associated With Longer Hospital Length of Stay in Medium Vessel Occlusion Stroke
AU - Mei, Janet
AU - Salim, Hamza Adel
AU - Lakhani, Dhairya A.
AU - Balar, Aneri
AU - Vagal, Vaibhav
AU - Koneru, Manisha
AU - Wolman, Dylan
AU - Xu, Risheng
AU - Urrutia, Victor
AU - Marsh, Elisabeth Breese
AU - Pulli, Benjamin
AU - Hoseinyazdi, Meisam
AU - Luna, Licia
AU - Deng, Francis
AU - Hyson, Nathan Z.
AU - Bahouth, Mona
AU - Dmytriw, Adam A.
AU - Guenego, Adrien
AU - Albers, Gregory W.
AU - Lu, Hanzhang
AU - Nael, Kambiz
AU - Hillis, Argye E.
AU - Llinas, Raf
AU - Wintermark, Max
AU - Faizy, Tobias D.
AU - Heit, Jeremy J.
AU - Yedavalli, Vivek
N1 - Publisher Copyright:
© 2025 American Society of Neuroimaging.
PY - 2025/1/1
Y1 - 2025/1/1
N2 - Background and purpose: Prolonged length of stay (LOS) following a stroke is associated with unfavorable clinical outcomes. Factors predicting LOS in medium vessel occlusion (MeVO), impacting up to 40% of acute ischemic stroke (AIS) cases, remain underexplored. This study aims to investigate the predictors of LOS in AIS-MeVO. Methods: We conducted a retrospective analysis of prospectively maintained stroke databases, comprising AIS cases with MeVO in the anterior circulation, assessed by adequate CT perfusion (CTP). Baseline and clinical data were obtained from electronic health records. Alberta Stroke Program Early CT Scores (ASPECTS) were calculated from non-contrast head CT. The perfusion mismatch volume (time to maximum > 6 s minus relative cerebral blood flow <30%) volume was reported from CTP. Multiple regression was employed to examine the relationship between baseline parameters and hospital LOS. Results: A total of 133 patients (median age 71 [interquartile range 63–80] years, 59.4% females) were included in the study cohort. The perfusion mismatch volume significantly positively correlated with LOS (r = 0.264, p = 0.004). After adjusting for age, sex, hypertension, diabetes, prior stroke or transient ischemic attack, admission NIHSS, ASPECTS, Tan score, intravenous thrombolysis, mechanical thrombectomy (MT), and hemorrhagic transformation, a larger mismatch volume remained independently associated with longer hospital stays (β = 0.209, 95% confidence interval [CI] 0.006–0.412, p = 0.045). Additional significant determinants of longer hospital stay included admission NIHSS (β = 0.250, 95% CI: 0.060–0.440, p = 0.010) and MT (β = 0.208, 95% CI: 0.006–0.410, p = 0.044). Among patients who underwent MT (n = 83), multiple regression analysis incorporating both perfusion mismatch volume and admission NIHSS revealed that perfusion mismatch volume remained independently associated with LOS (β = 0.248, 95% CI: 0.019–0.471, p = 0.033), while admission NIHSS did not retain significance (β = 0.208, 95% CI: 0.019–0.433, p = 0.071). Conclusions: In our cohort of AIS patients with MeVO in the anterior circulation, and particularly in those who underwent MT, the perfusion mismatch volume serves as an independent predictor of LOS. These findings offer critical valuable insights in clinical assessments and decision-making protocols of MT in AIS-MeVO.
AB - Background and purpose: Prolonged length of stay (LOS) following a stroke is associated with unfavorable clinical outcomes. Factors predicting LOS in medium vessel occlusion (MeVO), impacting up to 40% of acute ischemic stroke (AIS) cases, remain underexplored. This study aims to investigate the predictors of LOS in AIS-MeVO. Methods: We conducted a retrospective analysis of prospectively maintained stroke databases, comprising AIS cases with MeVO in the anterior circulation, assessed by adequate CT perfusion (CTP). Baseline and clinical data were obtained from electronic health records. Alberta Stroke Program Early CT Scores (ASPECTS) were calculated from non-contrast head CT. The perfusion mismatch volume (time to maximum > 6 s minus relative cerebral blood flow <30%) volume was reported from CTP. Multiple regression was employed to examine the relationship between baseline parameters and hospital LOS. Results: A total of 133 patients (median age 71 [interquartile range 63–80] years, 59.4% females) were included in the study cohort. The perfusion mismatch volume significantly positively correlated with LOS (r = 0.264, p = 0.004). After adjusting for age, sex, hypertension, diabetes, prior stroke or transient ischemic attack, admission NIHSS, ASPECTS, Tan score, intravenous thrombolysis, mechanical thrombectomy (MT), and hemorrhagic transformation, a larger mismatch volume remained independently associated with longer hospital stays (β = 0.209, 95% confidence interval [CI] 0.006–0.412, p = 0.045). Additional significant determinants of longer hospital stay included admission NIHSS (β = 0.250, 95% CI: 0.060–0.440, p = 0.010) and MT (β = 0.208, 95% CI: 0.006–0.410, p = 0.044). Among patients who underwent MT (n = 83), multiple regression analysis incorporating both perfusion mismatch volume and admission NIHSS revealed that perfusion mismatch volume remained independently associated with LOS (β = 0.248, 95% CI: 0.019–0.471, p = 0.033), while admission NIHSS did not retain significance (β = 0.208, 95% CI: 0.019–0.433, p = 0.071). Conclusions: In our cohort of AIS patients with MeVO in the anterior circulation, and particularly in those who underwent MT, the perfusion mismatch volume serves as an independent predictor of LOS. These findings offer critical valuable insights in clinical assessments and decision-making protocols of MT in AIS-MeVO.
KW - CT perfusion
KW - length of stay
KW - medium vessel occlusion
KW - perfusion mismatch
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U2 - 10.1111/jon.70015
DO - 10.1111/jon.70015
M3 - Article
C2 - 39835337
AN - SCOPUS:85215548816
SN - 1051-2284
VL - 35
JO - Journal of Neuroimaging
JF - Journal of Neuroimaging
IS - 1
M1 - e70015
ER -