Impaired Distal Perfusion Predicts Length of Hospital Stay in Patients with Symptomatic Middle Cerebral Artery Stenosis

Perfusion imaging can risk stratify patients with symptomatic intracranial stenosis. We aim to determine the association between perfusion delay and length of hospital stay (LOS) in symptomatic middle cerebral artery (MCA) stenosis patients.This is a retrospective study of consecutive patients admitted to a comprehensive stroke center over 5 years with ischemic stroke or transient ischemic attack (TIA) within 7 days of symptom onset due to MCA stenosis (50-99%) and underwent perfusion imaging. Patients were divided into three groups: mismatch volume ≥ 15 cc based on T max6 second delay, T max 4-6 second delay, and4 second delay. The outcome was LOS, both as a continuous variable and categorical (≥7 days [prolonged LOS] vs.7 days). We used adjusted regression analyses to determine the association between perfusion categories and LOS.One hundred and seventy eight of 194 patients met the inclusion criteria. After adjusting for age and NIHSS, T max6 second mismatch was associated with prolonged LOS (OR 2.94 95% CI 1.06-8.18; P = .039), but T max 4-6 second was not (OR 1.45 95% CI .46-4.58, P = .528). We found similar associations when LOS was a continuous variable for T max6 second (β coefficient = 2.01, 95% CI .05-3.97, P = .044) and T max 4-6 second (β coefficient = 1.24, 95% CI -.85 to 3.34, P = .244).In patients with symptomatic MCA stenosis, T max6 second perfusion delay is associated with prolonged LOS. Prospective studies are needed to validate our findings.