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Review ArticleNEUROVASCULAR/STROKE IMAGING

Role of Hypoperfusion Intensity Ratio in Vessel Occlusions: A Review on Safety and Clinical Outcomes

Sana Rehman, Arsalan Nadeem, Arbab Burhan Uddin Kasi, Ali Husnain, Summaiyya Waseem, Sohail Kumar, Syed Muhammad Owais, Nasreen Banu, Dhairya A. Lakhani, Hamza A. Salim, Risheng Xu, Vaibhav S. Vagal, Yasmin N. Aziz, Argye E. Hillis, Victor C. Urrutia, Rafael H. Llinas, Elisabeth B. Marsh, Richard Leigh, Hanzhang Lu, Adam A. Dmytriw, Adrien Guenego, Gregory W. Albers, Jeremy J. Heit, Tobias D. Faizy and Vivek S. Yedavalli
American Journal of Neuroradiology May 2025, DOI: https://doi.org/10.3174/ajnr.A8557
Sana Rehman
aFrom the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., G.W.A., V.S.Y.), Johns Hopkins University, Baltimore, Maryland
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Arsalan Nadeem
bDepartment of Medicine (A.N.), Allama Iqbal Medical College, Lahore, Pakistan
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Arbab Burhan Uddin Kasi
cMass General Brigham (A.B.U.K.), Boston, Massachusetts
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Ali Husnain
dDivision of Interventional Radiology, Department of Radiology, Section of Interventional Radiology (A.H.), Northwestern Memorial Hospital, Chicago, Illinois
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Summaiyya Waseem
eDow University of Health Sciences (S.W.), Karachi, Pakistan
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Sohail Kumar
fHMH JFK University Medical Center (S.K.), Edison, New Jersey
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Syed Muhammad Owais
gUniversity of Toledo (S.M.O.), Toledo, Ohio
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Nasreen Banu
hShadan Institute of Medical Sciences (N.B.), Hyderabad, Telangana, India
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Dhairya A. Lakhani
aFrom the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., G.W.A., V.S.Y.), Johns Hopkins University, Baltimore, Maryland
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Hamza A. Salim
aFrom the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., G.W.A., V.S.Y.), Johns Hopkins University, Baltimore, Maryland
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Risheng Xu
aFrom the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., G.W.A., V.S.Y.), Johns Hopkins University, Baltimore, Maryland
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Vaibhav S. Vagal
iStony Brook University Renaissance School of Medicine (V.S.V.), New York, New York
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Yasmin N. Aziz
jUniversity of Cincinnati College of Medicine (Y.N.A.), Cincinnati, Ohio
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Argye E. Hillis
aFrom the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., G.W.A., V.S.Y.), Johns Hopkins University, Baltimore, Maryland
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Victor C. Urrutia
aFrom the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., G.W.A., V.S.Y.), Johns Hopkins University, Baltimore, Maryland
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Rafael H. Llinas
aFrom the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., G.W.A., V.S.Y.), Johns Hopkins University, Baltimore, Maryland
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Elisabeth B. Marsh
aFrom the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., G.W.A., V.S.Y.), Johns Hopkins University, Baltimore, Maryland
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Richard Leigh
kDepartment of Neurology (R.L.), Johns Hopkins Medicine, Baltimore, Maryland
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Hanzhang Lu
aFrom the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., G.W.A., V.S.Y.), Johns Hopkins University, Baltimore, Maryland
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Adam A. Dmytriw
lNeuroendovascular Program (A.A.D.), Massachusetts General Hospital, Boston, Massachusetts
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Adrien Guenego
mDepartment of Diagnostic and Interventional Neuroradiology (A.G.), Erasme University Hospital, Brussels, Belgium
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Gregory W. Albers
aFrom the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., G.W.A., V.S.Y.), Johns Hopkins University, Baltimore, Maryland
nDepartment of Neurology (G.W.A., J.J.H.), Stanford University, Stanford, California.
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Jeremy J. Heit
nDepartment of Neurology (G.W.A., J.J.H.), Stanford University, Stanford, California.
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Tobias D. Faizy
oDepartment of Radiology, Neuroendovascular Program (T.D.F.), University Medical Center Münster, Munster, Germany
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Vivek S. Yedavalli
aFrom the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., G.W.A., V.S.Y.), Johns Hopkins University, Baltimore, Maryland
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Article Information

DOI 
https://doi.org/10.3174/ajnr.A8557
PubMed 
39477546

Published By 
American Journal of Neuroradiology
Print ISSN 
0195-6108
Online ISSN 
1936-959X
History 
  • Received August 20, 2024
  • Accepted after revision October 24, 2024
  • Published online May 22, 2025.

Article Versions

  • Latest version (October 30, 2024 - 10:38).
  • You are viewing the most recent version of this article.
Copyright & Usage 
© 2025 by American Journal of Neuroradiology

Author Information

  1. Sana Rehmana,
  2. Arsalan Nadeemb,
  3. Arbab Burhan Uddin Kasic,
  4. Ali Husnaind,
  5. Summaiyya Waseeme,
  6. Sohail Kumarf,
  7. Syed Muhammad Owaisg,
  8. Nasreen Banuh,
  9. Dhairya A. Lakhania,
  10. Hamza A. Salima,
  11. Risheng Xua,
  12. Vaibhav S. Vagali,
  13. Yasmin N. Azizj,
  14. Argye E. Hillisa,
  15. Victor C. Urrutiaa,
  16. Rafael H. Llinasa,
  17. Elisabeth B. Marsha,
  18. Richard Leighk,
  19. Hanzhang Lua,
  20. Adam A. Dmytriwl,
  21. Adrien Guenegom,
  22. Gregory W. Albersa,n,
  23. Jeremy J. Heitn,
  24. Tobias D. Faizyo and
  25. Vivek S. Yedavallia
  1. aFrom the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., G.W.A., V.S.Y.), Johns Hopkins University, Baltimore, Maryland
  2. bDepartment of Medicine (A.N.), Allama Iqbal Medical College, Lahore, Pakistan
  3. cMass General Brigham (A.B.U.K.), Boston, Massachusetts
  4. dDivision of Interventional Radiology, Department of Radiology, Section of Interventional Radiology (A.H.), Northwestern Memorial Hospital, Chicago, Illinois
  5. eDow University of Health Sciences (S.W.), Karachi, Pakistan
  6. fHMH JFK University Medical Center (S.K.), Edison, New Jersey
  7. gUniversity of Toledo (S.M.O.), Toledo, Ohio
  8. hShadan Institute of Medical Sciences (N.B.), Hyderabad, Telangana, India
  9. iStony Brook University Renaissance School of Medicine (V.S.V.), New York, New York
  10. jUniversity of Cincinnati College of Medicine (Y.N.A.), Cincinnati, Ohio
  11. kDepartment of Neurology (R.L.), Johns Hopkins Medicine, Baltimore, Maryland
  12. lNeuroendovascular Program (A.A.D.), Massachusetts General Hospital, Boston, Massachusetts
  13. mDepartment of Diagnostic and Interventional Neuroradiology (A.G.), Erasme University Hospital, Brussels, Belgium
  14. nDepartment of Neurology (G.W.A., J.J.H.), Stanford University, Stanford, California.
  15. oDepartment of Radiology, Neuroendovascular Program (T.D.F.), University Medical Center Münster, Munster, Germany
  1. Please address correspondence to Vivek S. Yedavalli, Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD 21287; e-mail: vyedava1{at}jhmi.edu; @vsyedavalli; @thedocarsalan; @reh84315851
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Sana Rehman, Arsalan Nadeem, Arbab Burhan Uddin Kasi, Ali Husnain, Summaiyya Waseem, Sohail Kumar, Syed Muhammad Owais, Nasreen Banu, Dhairya A. Lakhani, Hamza A. Salim, Risheng Xu, Vaibhav S. Vagal, Yasmin N. Aziz, Argye E. Hillis, Victor C. Urrutia, Rafael H. Llinas, Elisabeth B. Marsh, Richard Leigh, Hanzhang Lu, Adam A. Dmytriw, Adrien Guenego, Gregory W. Albers, Jeremy J. Heit, Tobias D. Faizy, Vivek S. Yedavalli
Role of Hypoperfusion Intensity Ratio in Vessel Occlusions: A Review on Safety and Clinical Outcomes
American Journal of Neuroradiology May 2025, DOI: 10.3174/ajnr.A8557

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Role of Hypoperfusion Intensity Ratio in Vessel Occlusions: A Review on Safety and Clinical Outcomes
Sana Rehman, Arsalan Nadeem, Arbab Burhan Uddin Kasi, Ali Husnain, Summaiyya Waseem, Sohail Kumar, Syed Muhammad Owais, Nasreen Banu, Dhairya A. Lakhani, Hamza A. Salim, Risheng Xu, Vaibhav S. Vagal, Yasmin N. Aziz, Argye E. Hillis, Victor C. Urrutia, Rafael H. Llinas, Elisabeth B. Marsh, Richard Leigh, Hanzhang Lu, Adam A. Dmytriw, Adrien Guenego, Gregory W. Albers, Jeremy J. Heit, Tobias D. Faizy, Vivek S. Yedavalli
American Journal of Neuroradiology May 2025, DOI: 10.3174/ajnr.A8557
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  • Article
    • SUMMARY:
    • ABBREVIATIONS:
    • PATHOPHYSIOLOGY OF VESSEL OCCLUSIONS
    • HIR
    • LVO
    • DISTAL MEDIUM-VESSEL OCCLUSION
    • HIR IN COMPARISON WITH OTHER MODALITIES
    • HYPOPERFUSION INDICES MEASUREMENT TECHNIQUES
    • LIMITATIONS, FUTURE DIRECTIONS, AND IMPLICATIONS
    • CONCLUSIONS
    • Footnotes
    • References
  • Figures & Data
  • Supplemental
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  • Factors Associated With Prolonged Venous Transit in Large Vessel Occlusion Acute Ischemic Strokes
    Hamza Adel Salim, Dhairya A. Lakhani, Aneri B. Balar, Janet Mei, Licia Luna, Mona Shahriari, Nathan Z. Hyson, Francis Deng, Adam A. Dmytriw, Adrien Guenego, Victor C. Urrutia, Elisabeth B. Marsh, Hanzhang Lu, Risheng Xu, Rich Leigh, Gaurang Shah, Sijin Wen, Gregory W. Albers, Argye E. Hillis, Rafael Llinas, Kambiz Nael, Max Wintermark, Jeremy J. Heit, Tobias D. Faizy, Vivek S. Yedavalli
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  • The relative cerebral blood volume (rCBV) < 42% is independently associated with hemorrhagic transformation in anterior circulation large vessel occlusion
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    Interventional Neuroradiology 2025
  • Clinical outcomes of patients with unsuccessful mechanical thrombectomy versus best medical management of medium vessel occlusion stroke in the middle cerebral artery territory
    Tobias D Faizy, Vivek Yedavalli, Hamza Adel Salim, Dhairya A Lakhani, Basel Musmar, Nimer Adeeb, Muhammed Amir Essibayi, Motaz Daraghma, Kareem El Naamani, Nils Henninger, Sri Hari Sundararajan, Anna Luisa Kuhn, Jane Khalife, Sherief Ghozy, Luca Scarcia, Leonard LL Yeo, Benjamin YQ Tan, Robert W Regenhardt, Jeremy Josef Heit, Nicole M Cancelliere, Aymeric Rouchaud, Jens Fiehler, Sunil A Sheth, Ajit S Puri, Christian Dyzmann, Marco Colasurdo, Leonardo Renieri, João Pedro Filipe, Pablo Harker, Răzvan Alexandru Radu, Mohamad Abdalkader, Piers Klein, Thomas R Marotta, Julian Spears, Takahiro Ota, Ashkan Mowla, Pascal Jabbour, Arundhati Biswas, Frédéric Clarençon, James E Siegler, Thanh N Nguyen, Ricardo Varela, Amanda Baker, David Altschul, Nestor Gonzalez, Markus A Möhlenbruch, Vincent Costalat, Benjamin Gory, Christian Paul Stracke, Constantin Hecker, Gaultier Marnat, Hamza Shaikh, Christoph J Griessenauer, David S Liebeskind, Alessandro Pedicelli, Andrea Maria Alexandre, Illario Tancredi, Erwah Kalsoum, Max Wintermark, Boris Lubicz, Aman B Patel, Vitor Mendes Pereira, Adam A Dmytriw, Adrien Guenego
    Journal of NeuroInterventional Surgery 2025
  • Efficacy and safety of mechanical thrombectomy in distal medium middle cerebral artery occlusion ischemic stroke patients on low-dose aspirin
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