Role of Computed Tomography Angiography Enhancement Ratio in Predicting Prognosis in Patients with Stroke Undergoing Endovascular Treatment

Background The computed tomography angiography enhancement ratio (CTA‐ER), calculated through the net water uptake formula, is a valuable predictive tool for detecting adverse events after stroke. However, limited research has investigated the correlation between CTA‐ER and the prognosis of patients receiving endovascular treatment. Therefore, we aimed to examine whether CTA‐ER could predict favorable outcomes in patients undergoing endovascular treatment. Methods We conducted a retrospective study enrolling patients with acute anterior circulation large‐vessel occlusive stroke undergoing endovascular treatment between January 2016 and January 2023. All patients received noncontrast computed tomography and computed tomography angiography scans upon admission. Multivariate logistic regression analysis and receiver operator characteristic curve were used to assess the predictive efficacy in determining favorable outcomes. The favorable outcome at 90 days was a modified Rankin scale score of 0 to 2. Results A total of 206 participants (median age, 68 [60–77] years; 77 women) were included in the study, with 82 (39.8%) individuals demonstrating favorable outcomes. Patients with favorable outcomes had lower noncontrast computed tomography net water uptake (6.42% versus 7.76%; P < 0.001) and CTA‐ER (8.31% versus 10.56%; P < 0.001). Multivariate logistic regression analysis identified that CTA‐ER was a significant predictor for favorable outcomes (P<0.05 in all models). Furthermore, the receiver operator characteristic analysis revealed that CTA‐ER exhibited superior predictive performance, surpassing noncontrast computed tomography net water uptake (area under the curve, 0.707 versus 0.636, Delong test; P = 0.046). Conclusion CTA‐ER is a significant predictor of favorable outcomes in patients with acute large‐vessel occlusion stroke undergoing endovascular treatment.