Objective:

To investigate the dynamic changes, influencing factors, and prognostic significance of the asymmetric prominent vessel sign (APVS) in patients with atherosclerotic anterior circulation acute ischemic stroke (AIS).

Approach:

• Study Design: Retrospective study of patients with atherosclerotic anterior circulation AIS admitted within 48 hours after symptom onset.
• Data Collection: Clinical and imaging data were collected, including vascular stenosis, SWI-DWI mismatch, NIHSS scores, infarct volume, and mRS scores.
• Patient Grouping: Patients were categorized into significant APVS change group (≥2 points) and non-significant change group (0–1 point) based on SWI-ASPECTS scores.
• Statistical Analysis: Univariate analyses were performed to explore factors associated with APVS changes and their relationship with clinical outcomes.

Key Findings:

• Among 34 patients, 11 were in the significant APVS change group.
• APVS extent remained unchanged in 38.2% of patients, decreased in 58.8% (including complete disappearance in 17.6%), and increased in 2.9%.
• Patients in the significant change group had larger baseline infarct volumes (T = −2.191, p = 0.028) and post-treatment infarct volumes (T = −2.779, p = 0.005), a higher proportion of severe vascular stenosis (p = 0.009), and higher baseline SWI-ASPECTS scores (T = −3.117, p = 0.002).
• No statistically significant differences were observed in early neurological deterioration or 90-day mRS scores between groups.

Interpretation:

APVS extent decreased or disappeared in most patients after treatment, with certain baseline factors influencing APVS evolution.

Limitations:

• Small sample size of 34 patients.
• Retrospective design may introduce bias.
• Lack of long-term follow-up data.

Conclusion:

APVS changes are influenced by baseline infarct volumes, vascular stenosis, and SWI-ASPECTS scores.