RT Journal Article
SR Electronic
T1 Association of Pretreatment Perfusion Imaging Parameters with 90-Day Excellent Functional Outcomes in Anterior Circulation Distal Medium Vessel Occlusion Stroke
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 892
OP 899
DO 10.3174/ajnr.A8584
VO 46
IS 5
A1 Salim, Hamza Adel
A1 Vagal, Vaibhav
A1 Lakhani, Dhairya A.
A1 Mei, Janet
A1 Luna, Licia
A1 Aziz, Yasmin
A1 Balar, Aneri
A1 Dmytriw, Adam A.
A1 Guenego, Adrien
A1 Musmar, Basel
A1 Adeeb, Nimer
A1 Urrutia, Victor C.
A1 Marsh, Elisabeth B.
A1 Llinas, Raf
A1 Hillis, Argye E.
A1 Lu, Hanzhang
A1 Xu, Risheng
A1 Wolman, Dylan
A1 Pulli, Benjamin
A1 Nael, Kambiz
A1 Wintermark, Max
A1 Heit, Jeremy J.
A1 Albers, Gregory W.
A1 Faizy, Tobias D.
A1 Yedavalli, Vivek
YR 2025
UL http://www.ajnr.org/content/46/5/892.abstract
AB BACKGROUND AND PURPOSE: Acute ischemic strokes caused by distal medium vessel occlusions (DMVOs) represent a remarkable proportion of all stroke cases, yet the predictors of excellent functional outcomes in these patients remain poorly understood. This study aims to identify pretreatment CTP parameters associated with excellent functional outcomes, defined as an mRS score of 0–1 at 90 days, in patients with anterior circulation DMVO.MATERIALS AND METHODS: We conducted a retrospective multicenter study involving patients with anterior DMVO, from 2 stroke centers within the Johns Hopkins Medical Enterprise. Baseline demographic, clinical, and imaging data were collected, with CTP parameters analyzed by using RapidAI software. Univariable and multivariable logistic regression models were used to identify predictors of excellent outcomes. Receiver operating characteristic (ROC) curves were constructed to assess the predictive accuracy of CTP parameters.RESULTS: Among the 82 patients (median age, 71 years; 57% women), occlusions were located in the M2 segment in 89%, M3 in 8.5%, and A2 in 2.4%. Intravenous thrombolysis (IVT) was administered to 37% of patients, and endovascular therapy (EVT) was attempted in 59%. Excellent outcomes at 90 days were achieved in 45% of patients. In univariate analysis, white race (OR, 4.14; 95% CI, 1.66–10.9; P = .003), higher CBV index (OR per 0.1-unit change, 1.45; 95% CI, 1.08–2.05; P = .022), and lower relative CBF (rCBF <20%) volumes (OR, 0.91; 95% CI, 0.81–0.98; P = .038) were significantly associated with excellent outcomes. In multivariate analysis adjusting for age, sex, race, IVT administration, EVT attempted, dyslipidemia, and premorbid mRS, higher CBV index remained a significant independent predictor (OR per 0.1-unit change, 1.72; 95% CI, 1.14–2.81; P = .017), and lower rCBF <20% volume was associated with better outcomes (OR, 0.91; 95% CI, 0.80–0.98; P = .05). The multivariate model demonstrated good predictive performance (area under the ROC curve, 80%; 95% CI, 70%–90%; P < .001).CONCLUSIONS: In patients with anterior circulation DMVO, a higher CBV index on pretreatment CTP is an independent predictor of excellent functional outcomes at 90 days. These findings suggest that CTP parameters, particularly the CBV index, may be useful in prognostic assessment for this stroke population. Further studies are needed to validate these results and optimize therapeutic approaches.ACAanterior cerebral arteryAUCarea under the curveDMVOdistal medium vessel occlusionEVTendovascular therapyHIRhyperfusion intensity ratioIQRinterquartile rangeIVTintravenous thrombolysisLVOlarge vessel occlusionmTICImodified TICIROCreceiver operating characteristicrCBFrelative Cerebral blood flow (CBF)Tmaxtime to maximum