Hemodynamics of distal cerebral arteries are associated with functional outcomes in symptomatic middle cerebral artery ischemic stroke

Motivation: The relationship between cerebral hemodynamics and ischemic stroke (IS) prognosis is still not fully understood. Goal(s): This study aims to investigate the associations of hemodynamics with IS functional outcomes at both 90 days and one year in IS patients with confirmed ipsilateral stroke attributed to MCA territory using 4D flow CMR. Approach: Hemodynamics and vessel characteristics of atherosclerotic lesions and hemodynamics of pre-bifurcation M1 (pM1) and distal M1 and/or first branch of M2 (dM1/M2) segments were calculated. Results: TAWSS and RRT of dM1/M2 segments showed moderate estimate performance in identifying poor functional outcomes (mRS≥3) both at 90 days and one year. Impact: Segment-level TAWSS, RRT of dM1/2 segments may be helpful to facilitate the differentiation of poor and favorable functional outcomes. Our results imply the potential values of distal segment-level hemodynamic parameters derived from 4D flow CMR for the prognosis of IS.