BACKGROUND AND PURPOSE We have observed that large vessel occlusion acute strokes (LVOS) due to intracranial atherosclerotic disease (ICAD) present with more benign CT perfusion (CTP) profiles, which we presume to potentially represent enhanced collateralization compared to embolic LVOS. We aim to determine if CTP profiles can predict ICAD in LVOS. METHODS Retrospective review of a prospectively collected interventional stroke database from September 2010 to March 2015. Patients with intracranial ICA/MCA-M1/M2 occlusions and CTP were dichotomized into ICAD versus non-ICAD etiologies. Ischemic core (relative cerebral blood flow < 30%) and hypoperfusion volumes were estimated by automated CTP. RESULTS A total of 250 patients met the inclusion criteria, comprised of 21 (8%) ICAD and 229 non-ICAD etiologies. Baseline characteristics were similar between groups, except for higher HbA1c levels (p < 0.01), LDL cholesterol (p < 0.01), systolic blood pressure (p < 0.01), and lower rate of atrial fibrillation (p < 0.01) in ICAD patients. There were no significant differences in volumes of baseline ischemic core (p = 0.54) among groups. ICAD patients had smaller Tmax > 4 s, Tmax > 6 s, and Tmax > 10 s absolute lesions, and a higher ratio of Tmax > 4 s/Tmax > 6 s volumes (median 2 [1.6-2.3] vs. 1.6 [1.4-2.0]; p = 0.02). A Tmax > 4 s/Tmax > 6 s ratio ≥2 showed specificity = 73%/sensitivity = 52% for ICAD and was observed in 47.6% of ICAD versus 26.1% of non-ICAD patients (p = 0.07). Clinical outcomes were comparable amongst groups. Multivariate logistic regression revealed that Tmax > 4 s/Tmax > 6 s ratio ≥2 (OR 3.75, 95% CI 1.05-13.14, p = 0.04), higher LDL cholesterol (OR 1.1, 95% CI 1.01-1.03, p = 0.01), and higher systolic pressure (OR 1.03, 95% CI 1.01-1.04, p = 0.01) were independently associated with ICAD. CONCLUSION An automated CTP Tmax > 4 s/Tmax > 6 s ratio ≥2 profile was found independently associated with underlying ICAD LVOS.

中文翻译：

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颅内动脉粥样硬化疾病大血管急性中风的自动 CT 灌注预测。

背景和目的 我们观察到由颅内动脉粥样硬化疾病 (ICAD) 引起的大血管闭塞性急性卒中 (LVOS) 表现出更良性的 CT 灌注 (CTP) 特征，我们认为与栓塞性 LVOS 相比，这可能代表侧支循环增强。我们旨在确定 CTP 配置文件是否可以预测 LVOS 中的 ICAD。方法 回顾性回顾 2010 年 9 月至 2015 年 3 月前瞻性收集的介入性卒中数据库。颅内 ICA/MCA-M1/M2 闭塞和 CTP 患者分为 ICAD 和非 ICAD 病因。通过自动 CTP 估计缺血核心（相对脑血流量 < 30%）和低灌注量。结果 共有 250 名患者符合纳入标准，包括 21 (8%) 名 ICAD 和 229 名非 ICAD 病因。除了 ICAD 患者的 HbA1c 水平 (p < 0.01)、LDL 胆固醇 (p < 0.01)、收缩压 (p < 0.01) 和房颤发生率较低 (p < 0.01) 之外，各组的基线特征相似。各组之间基线缺血核心的体积没有显着差异（p = 0.54）。ICAD 患者的 Tmax > 4 s、Tmax > 6 s 和 Tmax > 10 s 绝对病灶较小，Tmax > 4 s/Tmax > 6 s 体积的比值更高（中位数 2 [1.6-2.3] vs. 1.6 [1.4 -2.0]；p = 0.02)。Tmax > 4 s/Tmax > 6 s 比率≥2 表明 ICAD 的特异性 = 73%/敏感性 = 52%，在 ICAD 患者中观察到 47.6% 与在非 ICAD 患者中观察到 26.1% (p = 0.07)。临床结果在各组之间具有可比性。多变量逻辑回归显示 Tmax > 4 s/Tmax > 6 s 比率≥2（OR 3.75，95% CI 1.05-13.14，p = 0.04），更高的 LDL 胆固醇（OR 1.1，95% CI 1.01-1.03，p = 0.01）和更高的收缩压（OR 1.03，95% CI 1.01-1.04，p = 0.01）与 ICAD 独立相关。结论 发现自动 CTP Tmax > 4 s/Tmax > 6 s 比率≥2 曲线与潜在的 ICAD LVOS 独立相关。