A retrospective analysis of a newly proposed imaging-etiologic classification for acute ischemic stroke with large vascular occlusion based on MRI and pathogenesis.

Background: Endovascular treatment (EVT) has emerged as the preferred initial therapeutic option for acute ischemic stroke (AIS) with large vascular occlusion (LVO). To facilitate more targeted EVT interventions, we propose a novel imaging-etiologic classification system derived from a comprehensive analysis of preoperative MRI and pathogenesis in AIS patients. Methods: From June 2020 to December 2021, a retrospective analysis was conducted on 184 consecutive AIS patients who underwent preoperative MRI and subsequent EVT at the Henan Provincial Cerebrovascular Hospital Stroke Center. Patients' medical histories were comprehensively reviewed. According to MRI, anterior circulation infarction (ACI) and posterior circulation infarction (PCI) were divided into four groups respectively (A-D & a-d). Three types (1-3) of etiology were identified based on pathogenesis. The types were respectively evaluated by screening test with intra-operative finding of EVT. Results: Our imaging-etiologic classification achieved an overall positive rate of 90.2% (166/184) when compared to the gold standard. The screening test for each type demonstrated excellent validity (Youden's index ≥ 0.75) and reliability (Kappa ≥ 0.80). Conclusion: The imaging-etiologic classification represents a simple yet comprehensive approach that can be readily applied in the management of AIS with LVO. It can rapidly and effectively locate the vascular occlusion, and reveal the pathogenesis.