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Association between three-territory sign and prognosis of acute ischemic stroke patients with malignancy

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机构: [1]Xi An Jiao Tong Univ, Affiliated Hosp 1, Dept Cardiovasc Surg, Xian, Peoples R China [2]Xi An Jiao Tong Univ, Stroke Ctr, Affiliated Hosp 1, Dept Neurol, Xian, Peoples R China [3]Xi An Jiao Tong Univ, Affiliated Hosp 1, Dept Neurol, Xian, Peoples R China [4]Capital Med Univ, Xuanwu Hosp, Innovat Ctr Neurol Disorders, Beijing, Peoples R China [5]Capital Med Univ, Xuanwu Hosp, Dept Neurol, Beijing, Peoples R China [6]Xi An Jiao Tong Univ, Biobank, Affiliated Hosp 1, Xian, Peoples R China
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关键词: three-territory sign ischemic stroke malignancy atrial fibrillation prognosis

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Background: Multiple cerebral infarcts are usually secondary to cardiogenic embolism, particularly through atrial fibrillation (AF). The three-territory sign (TTS) is an imaging marker that reflects multiple cerebral lesions involving three vascular territories measured by diffusion-weighted imaging (DWI), and the most common etiology is an underlying malignancy. Recent studies have shown that TTS is six times more frequently observed in acute ischemic stroke (AIS) patients with malignancy than in those with AF-related AIS. However, the relevance of TTS to the prognosis of IS patients with malignancy remains unclear. Methods: Over a 5-year period (May 2016 to 31 June 2021), AIS admissions with DWI were identified from the First Affiliated Hospital of Xi'an Jiaotong University. Patients were divided into two groups according to whether they had malignancy or AF, resulting in a total of 80 patients with known malignancy (malignancy group) and 92 patients with AF (AF group). All DWI images were reviewed to determine the territory lesion count. Demographic, clinical, and laboratory data, together with radiographic examination data and modified Rankin Scale (mRS) score within a year, were collected. The main outcome was the association between TTS and the prognosis of AIS patients with malignancy, analyzed by a multivariate logistic regression model. Results: A total of 172 patients met the selection criteria, including 17 (21.3%) patients in the malignancy group and 8 (8.7%) patients in the AF group with TTS. Age and sex distributions were similar for AIS patients of malignancy and AF. The TTS was 2.4 times more likely to be observed in AIS patients with malignancy compared to AF-related IS patients. The univariate analysis showed that hypertension (OR = 1.137, 95%CI: 1.002-1.291), D-dimer (OR = 1.328, 95%CI: 1.022-1.726), fibrin degradation product (OR = 1.117, 95%CI: 1.010-1.236), and lactate dehydrogenase (LDH; OR = 1.007, 95%CI: 1.000-1.015) were the risk factors for the high mortality rate. Multivariate analysis showed that TTS was the independent risk factor for mortality in AIS patients with malignancy (adjusted OR: 6.866, 95% CI: 1.371-34.395). Conclusion: TTS was more frequently observed in AIS patients with malignancy than AF-related AIS and substantially related to high poor outcome (mRS > 2) in AIS patients with malignancy, indicating diagnostic and prognostic value in malignancy-associated hypercoagulation stroke.

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出版当年[2022]版:
大类 | 3 区 医学
小类 | 3 区 神经科学 3 区 临床神经病学
最新[2023]版:
大类 | 3 区 医学
小类 | 3 区 临床神经病学 3 区 神经科学
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出版当年[2021]版:
Q2 CLINICAL NEUROLOGY Q2 NEUROSCIENCES
最新[2023]版:
Q2 CLINICAL NEUROLOGY Q3 NEUROSCIENCES

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第一作者机构: [1]Xi An Jiao Tong Univ, Affiliated Hosp 1, Dept Cardiovasc Surg, Xian, Peoples R China
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