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Pretreatment CTP Collateral Parameters Predict Good Outcomes in Successfully Recanalized Middle Cerebral Artery Distal Medium Vessel Occlusions

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Abstract

Background/Purpose

Distal medium vessel occlusions (DMVOs) account for a large percentage of vessel occlusions resulting in acute ischemic stroke (AIS) with disabling symptoms. We aim to assess whether pretreatment quantitative CTP collateral status (CS) parameters can serve as imaging biomarkers for good clinical outcomes prediction in successfully recanalized middle cerebral artery (MCA) DMVOs.

Methods

We performed a retrospective analysis of consecutive patients with AIS secondary to primary MCA-DMVOs who were successfully recanalized by mechanical thrombectomy (MT) defined as modified thrombolysis in cerebral infarction (mTICI) 2b, 2c, or 3. We evaluated the association between the CBV index and HIR independently with good clinical outcomes (modified Rankin score 0–2) using Spearman rank correlation, logistic regression, and ROC analyses.

Results

From 22 August 2018 to 18 October 2022 8/22/2018 to 10/18/2022, 60 consecutive patients met our inclusion criteria (mean age 71.2 ± 13.9 years old [mean ± SD], 35 female). The CBV index (r = −0.693, p < 0.001) and HIR (0.687, p < 0.001) strongly correlated with 90-day mRS.

A CBV index ≥ 0.7 (odds ratio, OR, 2.27, range 6.94–21.23 [OR] 2.27 [6.94–21.23], p = 0.001)) and lower likelihood of prior stroke (0.13 [0.33–0.86]), p = 0.024)) were independently associated with good outcomes.

The ROC analysis demonstrated good performance of the CBV index in predicting good 90-day mRS (AUC 0.73, p = 0.003) with a threshold of 0.7 for optimal sensitivity (71% [52.0–85.8%]) and specificity (76% [54.9–90.6%]). The HIR also demonstrated adequate performance in predicting good 90-day mRS (AUC 0.77, p = 0.001) with a threshold of 0.3 for optimal sensitivity (64.5% [45.4–80.8%]) and specificity (76.0% [54.9–90.6%]).

Conclusion

A CBV index ≥ 0.7 may be independently associated with good clinical outcomes in our cohort of AIS caused by MCA-DMVOs that were successfully treated with MT. Furthermore, a HIR < 0.3 is also associated with good clinical outcomes. This is the first study of which we are aware to identify a CBV index threshold for MCA-DMVOs.

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Authors and Affiliations

  1. Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Phipps B112-D, 21287, Baltimore, MD, USA

    Vivek Yedavalli, Manisha Koneru, Omar Hamam, Meisam Hoseinyazdi & Hanzhang Lu

  2. Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Elisabeth Breese Marsh, Raf Llinas, Victor Urrutia, Richard Leigh & Argye Hillis

  3. Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Fernando Gonzalez, Risheng Xu, Justin Caplan & Judy Huang

  4. Department of Radiology, University of Texas, MD Anderson, TX, USA

    Max Wintermark

  5. Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA

    Jeremy Heit

  6. Department of Radiology, Université libre de Bruxelles, Bruxelles, Belgium

    Adrien Guenego & Greg Albers

  7. Department of Neurology, Stanford University School of Medicine, Stanford, Ca, USA

    Vivek Yedavalli

  8. Department of Radiology, David Geffen UCLA School of Medicine, Los Angeles, Ca, USA

    Kambiz Nael

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  1. Vivek Yedavalli
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  2. Manisha Koneru
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  11. Justin Caplan
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  12. Judy Huang
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  13. Hanzhang Lu
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  15. Jeremy Heit
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  16. Adrien Guenego
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  18. Kambiz Nael
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  19. Argye Hillis
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Corresponding author

Correspondence to Vivek Yedavalli.

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Conflict of interest

V. Yedavalli, M. Koneru, O. Hamam, M. Hoseinyazdi, E.B. Marsh, R. Llinas, V. Urrutia, R. Leigh, F. Gonzalez, R. Xu, J. Caplan, J. Huang, H. Lu, M. Wintermark, J. Heit, A. Guenego, G. Albers, K. Nael and A. Hillis declare that they have no competing interests.

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Yedavalli, V., Koneru, M., Hamam, O. et al. Pretreatment CTP Collateral Parameters Predict Good Outcomes in Successfully Recanalized Middle Cerebral Artery Distal Medium Vessel Occlusions. Clin Neuroradiol 34, 341–349 (2024). https://doi.org/10.1007/s00062-023-01371-2

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  • DOI: https://doi.org/10.1007/s00062-023-01371-2

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