Impact of DSA-based Cerebral Microcirculation Time on Neurological Improvement at Discharge in Stroke Patients after Successful Recanalization

BACKGROUND: Whether cerebral microcirculation influences the likelihood of early neurological improvement (ENI) is poorly understood in patients with acute ischemic stroke (AIS). We assessed the microcirculation time using digital subtraction angiography (DSA) and analyzed its impact on ENI at discharge and long-term outcomes in AIS treated by endovascular treatment. METHODS: This was a retrospective cohort study of patients with AIS. All patients underwent standard cerebral DSA immediately after successful recanalization. We used the syngo iFlow software to assess the microvascular cerebral circulation time (mCCT) in the regions of interest on DSA. The primary outcome was ENI at discharge, defined as a decrease of ≥8 points or a National Institutes of Health Stroke Scale score of 0 or 1 when discharge. Logistic regression was conducted to analyze the impact of mCCT on prognosis. RESULTS: A total of 156 patients were included in the current study. The median age was 69 years, and 44.2% were male. Multivariate analysis showed that shorter mCCT was significantly associated with ENI at discharge (adjusted odds ratio[aOR] 4.79, 95% confidence interval [CI] 2.01-11.45, P<0.001) and functional independence at 90 days (aOR 3.64, 95% CI 1.53-8.67, P<0.001). The area under the receiver operating characteristic curve was significantly enhanced by including mCCT in the conventional model (0.830 vs 0.758, P=0.01, DeLong test). Finally, the mCCT model demonstrated good discrimination and calibration in this cohort, as well as the fivefold cross validation. CONCLUSION: DSA-based mCCT after successful recanalization is an independent predictor of ENI at discharge (aOR 4.79) and long-term functional outcomes (aOR 3.64).