Supplementary Material for: Multiparametric Neuroimaging and Its Association with Non-Contrast Computed Tomography in Late-Window Large Vessel Occlusion Acute Stroke

<b><i>Introduction:</i></b> Endovascular treatment (EVT) for acute ischemic stroke (AIS) between 6 and 24 h is established as a standard of care among patients selected by multiparametric neuroimaging. We aimed to explore neuroimaging parameters in late-window large vessel occlusion (LVO) patients and its association with non-contrast computed tomography (NCCT) findings. <b><i>Methods:</i></b> We included consecutive AIS patients within 6–24 h from the symptoms onset with LVO. We described multiparametric imaging findings, the rate of patients who fulfilled imaging perfusion criteria according to the DAWN and DEFUSE-3 trials that define the computed tomography perfusion mismatch (CTP-MM) group and its association with NCCT focused on Alberta Stroke Program Early CT Score (ASPECTS). We also analyzed the association between neuroimaging parameters and the clinical outcome determined by the 90-day modified Rankin scale (mRS). <b><i>Results:</i></b> We included 206 patients, of them, 176 (85.4%) presented CTP-MM and 184 (89.3%) presented an ASPECTS ≥6 on admission. The rate of CTP-MM was 90.8% in patients with ASPECTS ≥6, compared with 40.9% in those with low ASPECTS. ASPECTS was moderately correlated with ischemic core determined by cerebral blood flow &lt;30% volume (rS = −0.557, <i>p</i> &lt; 0.001). In EVT-treated patients (185, 89.8%), after adjusting for identifiable confounders, the presence of CTP-MM was a predictor of 90-day functional independence (OR: 3.38; 95% CI: 1.01–11.29; <i>p</i> = 0.048). We did not find an association between CTP-MM and 90-day functional disability (ordinal mRS shift, aOR: 1.39; 95% CI: 0.58–3.34; <i>p</i> = 0.459). <b><i>Conclusions:</i></b> A great majority of patients who presented a LVO in the late window fulfilled guidelines imaging criteria to undergo EVT, especially those with high ASPECTS (≥6). Our data suggest that NCCT with CT angiography could be a reasonable approach for AIS treatment selection also in the late window.

<b><i>引言：</i></b> 针对发病6至24小时的急性缺血性卒中（acute ischemic stroke, AIS）患者，经多参数神经影像筛选后，血管内治疗（endovascular treatment, EVT）已成为标准治疗方案。本研究旨在探究晚时间窗大血管闭塞（large vessel occlusion, LVO）患者的神经影像参数，及其与平扫计算机断层扫描（non-contrast computed tomography, NCCT）结果的关联。<b><i>方法：</i></b> 本研究纳入发病后6至24小时内确诊大血管闭塞的连续性急性缺血性卒中患者。我们描述了多参数影像学表现、符合DAWN与DEFUSE-3试验定义的计算机断层灌注不匹配（computed tomography perfusion mismatch, CTP-MM）组的患者占比，并分析其与以阿尔伯塔卒中项目早期CT评分（Alberta Stroke Program Early CT Score, ASPECTS）为核心的平扫CT结果之间的关联。此外，我们还分析了神经影像参数与通过90天改良Rankin量表（modified Rankin scale, mRS）评估的临床结局之间的相关性。<b><i>结果：</i></b> 本研究共纳入206例患者，其中176例（85.4%）符合CTP-MM标准，184例（89.3%）入院时ASPECTS≥6。ASPECTS≥6的患者中CTP-MM检出率为90.8%，而低ASPECTS患者的该检出率仅为40.9%。ASPECTS与脑血流量<30%体积所定义的缺血核心体积呈中度相关（秩相关系数rS = −0.557, <i>p</i> < 0.001）。在接受血管内治疗的185例患者（占比89.8%）中，校正混杂因素后，CTP-MM阳性是90天功能独立的预测因素（优势比OR: 3.38；95%置信区间CI: 1.01–11.29；<i>p</i> = 0.048）。未发现CTP-MM与90天功能残疾存在关联（有序mRS评分位移分析，校正优势比aOR: 1.39；95%CI: 0.58–3.34；<i>p</i> = 0.459）。<b><i>结论：</i></b> 绝大多数晚时间窗大血管闭塞患者符合血管内治疗的指南影像筛选标准，尤其是ASPECTS≥6的患者。本研究数据表明，联合CT血管造影的平扫CT可作为晚时间窗急性缺血性卒中患者治疗选择的合理评估方案。