Prediction Of The Risk Of Intracranial Hemorrhage And Prognosis Hemorrhage After Internal Carotid Or Middle Cerebral Artery Stent Implantation In Patients With Cerebral Infarction By Cranial CT Perfusion Combined With Cerebral White Matter Lesions

Objective:To discuss the risk of intracranial hemorrhage and prognosis after internal carotid or middle cerebral artery stent implantation in patients with cerebral infarction by cranial CT perfusion combined with cerebral white matter lesions.Methods:Acute ischemic stoke patients classified by TOAST as aortic atherosclerosis with unilateral internal carotid or middle cerebral artery stent implantation were recruited between January 2019 and December 2020 in the department of Neurology of the first affiliated hospital of Nanchang University.82 participants were admitted and we analyzed their medical records including general data,laboratory examination and auxiliary examination.The severity of stroke was assessed by using the National Institutes of Health Stroke Scale(NIHSS),and neurological function recovery was followed up 90 days after stent implantation by using modified Rankin score(MRS).SPSS25.0 software package was used for statistical analysis.According to the Fazekas classification,the WMLs were divided into mild group(grade 0-1)and moderate-to-severe group(grade 2-3),and the differences of WMLs perfusion in patients with different severity of WMLs were compared.ROC curve was used to determine the optimal diagnostic threshold value of CTP parameters for intracranial hemorrhage after stent implantation.According to the optimal diagnostic threshold value,all patients were divided into hypoperfusion group(peak time≥10.315s)and normal perfusion group(peak time <10.315s),the differences of the risk of hemorrhage and poor prognosis(m RS >2)after stent implantation were compared between the two groups.Then,they were divided into the group of hemorrhage and the group of non-hemorrhage according to whether the patients suffered cerebral hemorrhage after stent implantation.Univariate analysis was used to compare the differences in clinical data between the two groups.Multivariate Logistic regression analysis was used to further investigate the relationship between cerebral white matter hypoperfusion and intracranial hemorrhage after stent implantation in acute cerebral infarction.Results:1.A total of 82 patients with acute cerebral infarction were admitted in our study(age 62.6±9.3 years old,46 males,mean NIHSS score 10.7±9.1),There were18 patients smoking(22%)and 16 drinking(19.5%).35 patients(42.7%)had a history of hypertension,21 patients(25.6%)had a history of diabetes,12 patients(14.6%)had a history of hyperlipidemia,and 26 patients(31.7%)had a history of stroke.2.Results showed that the frontal lobe TTP was longer in the moderate-to-severe group(11.60±1.27 VS 10.65±1.20,P=0.001);the temporal lobe TTP was longer in the moderate-to-severe group(10.39(10.05-11.29)VS 10.03(9.89-10.36),P=0.000).3.The area of temporal lobe TTP under ROC curve was 0.839(95%CI,0.7555-0.924,P=0.000),and the optimal cut-off value of TTP for intracranial hemorrhage after stent implantation was 10.315 s.However,all parameters of CTP had no statistical significance for the optimal diagnostic cut-off for poor prognosis after intracranial stent implantation(m RS>2).4.Comparison of patients in the hypoperfusion group and the normal perfusion group showed that moderate-to-severe WMLs were more common in the hypoperfusion group(50.0% vs 24.1%,P=0.018),and intracranial hemorrhage after intracranial stent implantation was more common in the hypoperfusion group(71.4%vs 9.3%,P=0.000).But,there was no significant difference in poor prognosis after intracranial stent implantation(P> 0.05).5.Univariate analysis showed that compared with the group without intracerebral hemorrhage,the temporal lobe TTP ≥ 10.315 s was more common in the intracerebral hemorrhage group(80% vs 14%,P=0.000).In addition,after adjusting for age,NIHSS score at admission and other factors,multivariate regression analysis mentioned that the temporal lobe TTP ≥ 10.315 s was independently correlated with intracranial hemorrhage after stent implantation in patients with acute cerebral infarction(OR=2.645,CI=1.022-6.843,P=0.045).Conclusions:1.Cerebral blood flow insufficiency was correlated with the severity of WMLs,and the frontal and temporal lobe TTP was prolonged with the increase of the severity of WMLs.2.Cerebral perfusion insufficiency was independently associated with intracranial hemorrhage after internal carotid or middle cerebral artery stent implantation in patients with acute cerebral infarction,however,it did not increase the risk of poor prognosis.