High Hypoperfusion Intensity Ratio Is Independently Associated with Very Poor Outcomes in Large Ischemic Core Stroke

Vivek Yedavalli; Hamza Adel Salim; Dhairya A Lakhani; Aneri Balar; Janet Mei; Licia Luna; Francis Deng; Nathan Z Hyson; Jens Fiehler; Paul Stracke; Gabriel Broocks; Christian Heitkamp; Gregory W Albers; Max Wintermark; Tobias D Faizy; Jeremy J Heit

doi:10.1007/s00062-024-01463-7

High Hypoperfusion Intensity Ratio Is Independently Associated with Very Poor Outcomes in Large Ischemic Core Stroke

Clin Neuroradiol. 2024 Oct 7. doi: 10.1007/s00062-024-01463-7. Online ahead of print.

Authors

Vivek Yedavalli¹, Hamza Adel Salim^{2

3}, Dhairya A Lakhani², Aneri Balar², Janet Mei², Licia Luna², Francis Deng², Nathan Z Hyson², Jens Fiehler⁴, Paul Stracke⁵, Gabriel Broocks⁴, Christian Heitkamp⁴, Gregory W Albers⁶, Max Wintermark³, Tobias D Faizy⁵, Jeremy J Heit⁶

Affiliations

¹ Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA. vyedava1@jhmi.edu.
² Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.
³ Department of Neuroradiology, MD Anderson Medical Center, 77030, Houston, TX, USA.
⁴ Department of Radiology, Neuroendovascular Program, University Medical Center Hamburg, Hamburg, Germany.
⁵ Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Münster, Germany.
⁶ Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA.

PMID: 39373942
DOI: 10.1007/s00062-024-01463-7

Abstract

Background: Recent advances have highlighted the efficacy of endovascular thrombectomy (EVT) in patients with large ischemic core stroke, yet a significant portion still experience very poor outcomes, defined as a 90-day modified Rankin Score (mRS) of 5-6. This study aims to investigate the hypoperfusion intensity ratio (HIR) as a prognostic imaging parameter for these outcomes.

Methods: In a multicenter retrospective cohort study, data from consecutive patients undergoing EVT for acute ischemic stroke with large vessel occlusion (AIS-LVO) at two comprehensive stroke centers were analyzed. The study included patients with an Alberta Stroke Program Early CT Score (ASPECTS) of 5 or less and utilized pretreatment perfusion imaging to calculate HIR. The primary outcome was very poor outcomes (90 days mRS 5-6).

Results: Among 102 patients included, 59 (57.8%) had very poor outcome (90 days mRS 5-6). Multivariable logistic regression analysis adjusting for multiple covariates including admission National Institutes of Health Stroke Scale (NIHSS) and EVT revealed that higher admission NIHSS (adjusted odds ratio [aOR] 1.224, 95% CI 1.089-1.374, p = 0.001) and HIR (aOR per 0.1 incremental change, 1.34, 95% CI 1.02-1.82, P = 0.042) were independently associated with very poor outcomes.

Conclusion: This study demonstrates that admission NIHSS and HIR are independently associated with very poor outcome (90 days mRS 5-6) in patients with large ischemic core strokes. These findings highlight the importance of collateral status and perfusion imaging in predicting outcomes in this patient population, suggesting a potential role for HIR in the triage and management of large core stroke patients.