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Hypoperfusion Intensity Ratio Predicts Infarct Growth After Successful Thrombectomy for Distal Medium Vessel Occlusion

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Abstract

Background and Purpose

This study evaluated whether quantitative measurement of collaterals by the hypoperfusion intensity ratio (HIR) on baseline computed tomography perfusion (CTP) correlated with infarct growth and clinical outcome after successful endovascular recanalization of acute ischemic stroke (AIS) caused by primary distal medium vessel occlusions (DMVO).

Methods

We performed a retrospective analysis of consecutive AIS patients who underwent an initial CTP and were successfully recanalized by thrombectomy (modified thrombolysis In cerebral infarction 2b or 3) for DMVO. We evaluated the association of baseline HIR with infarct growth and clinical outcome.

Results

Between January 2018 and January 2021, 40 patients with an AIS caused by a DMVO were successfully recanalized by MT (65%, 26/40 female, median age 72 years, range 65–83 years). Baseline HIR was strongly correlated with infarct growth after successful recanalization (r = 0.501, p = 0.001).

An HIR<0.3 was the optimal threshold for good collaterals using ROC analysis. Patients with HIR ≥ 0.3 had higher infarct growth compared to HIR < 0.3 (23.8 mL, IQR: 9.1–45.1 vs. 7.2 mL, interquartile range (IQR): 4.2–11.7, relative risk 7.9, p = 0.024 in multivariate analysis); their clinical outcome was poorer in univariate analysis (75%, 21/28 patients with a 3 months modified Rankin scale of 0–2 vs. 33%,4/12, p < 0.017, odds ratio (OR) 6.0, 1.37–26.20) but it did not remain significant in multivariate analysis (p = 0.107).

Conclusion

Good collaterals on initial CTP assessed by an HIR < 0.3 are associated with less infarct growth after successful recanalization of AIS caused by a DMVO.

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Abbreviations

AIS:

Acute ischemic stroke

CT:

Computed tomography

CTP:

Computed tomography perfusion

DMVO:

Distal medium vessel occlusions

ECASS:

European cooperative stroke study

HIR:

Hypoperfusion intensity ratio

IVtPA:

Intravenous tissue plasminogen activator

LVO:

Large vessel occlusion

mRS:

Modified Rankin scale

MT:

Mechanical thrombectomy

NIHSS:

National Institutes of Health Stroke Scale

mTICI:

Modified thrombolysis in cerebral infarction

TMax>XXsec:

Volume of brain parenchyma (in mL) with a delay of Time-to-Maximum > XXsec on baseline CTP

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Authors and Affiliations

  1. Department of Interventional Neuroradiology, Erasme University Hospital, Route de Lennik 808, 1070, Brussels, Belgium

    Adrien Guenego, Yousra Farouki, Benjamin Mine, Thomas Bonnet, Franny Hulscher, Maud Wang, Stephanie Elens, Juan Vazquez Suarez & Boris Lubicz

  2. Department of Radiology, Leuven University Hospital, Leuven, Belgium

    Maud Wang

  3. Department of Neurology, Erasme University Hospital, Brussels, Belgium

    Lise Jodaitis, Noémie Ligot & Gilles Naeije

Authors
  1. Adrien Guenego
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  2. Yousra Farouki
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  3. Benjamin Mine
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  4. Thomas Bonnet
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  7. Stephanie Elens
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  9. Lise Jodaitis
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  10. Noémie Ligot
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  12. Boris Lubicz
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Contributions

All authors participated to study design, data collection, data analysis, writing.

Corresponding author

Correspondence to Adrien Guenego.

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Conflict of interest

A. Guenego, Y. Farouki, B. Mine, T. Bonnet, F. Hulscher, M. Wang, S. Elens, J. Vazquez Suarez, L. Jodaitis, N. Ligot, G. Naeije and B. Lubicz declare that they have no competing interests.

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The manuscript has not been submitted elsewhere or published elsewhere in whole or in part.

Statistical Analysis

Adrien Guenego conducted all the statistical analyses.

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Guenego, A., Farouki, Y., Mine, B. et al. Hypoperfusion Intensity Ratio Predicts Infarct Growth After Successful Thrombectomy for Distal Medium Vessel Occlusion. Clin Neuroradiol 32, 849–856 (2022). https://doi.org/10.1007/s00062-022-01141-6

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  • DOI: https://doi.org/10.1007/s00062-022-01141-6

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