Research & Innovation
Publications
Hypoperfusion Intensity Ratio Predicts Successful Recanalization in M2 MCA Occlusion Stroke Treated with Thrombectomy
PMU Authors
Constantin Hecker, Christoph Griessenauer, Monika Killer-Oberpfalzer
All Authors
Hamza Adel Salim, Alireza Kooshki, Dhairya A Lakhani, Meisam Hoseinyazdi, Tobias D Faizy, Jeremy J Heit, David S Liebeskind, Janet Mei, Dylan Wolman, Gregory W Albers, Aakanksha Sriwastwa, Andrew Cho, Adrien Guenego, Adam A Dmytriw, Vivek S Yedavalli, , Constantin Hecker, Christoph Griessenauer, Monika Killer-Oberpfalzer
Journal association
AMERICAN JOURNAL OF NEURORADIOLOGY
Abstract
BACKGROUND AND PURPOSE: The role of endovascular thrombectomy for acute ischemic stroke due to M2 MCA occlusion remains uncertain, in part because angiographic recanalization rates are lower than those achieved in large-vessel occlusion. The hypoperfusion intensity ratio (HIR), a perfusion-derived marker of collateral physiology, has been associated with infarct evolution and outcomes, but its relationship with the technical success of thrombectomy in M2 occlusion is unknown.
MATERIALS AND METHODS: In this retrospective, multinational study of the Multicenter Analysis of Primary Distal Medium Vessel Occlusions: Effect of Mechanical Thrombectomy (MAD-MT) Consortium registry, patients with M2 MCA occlusion who underwent EVT between September 2017 and July 2023 were included. Multivariable logistic regression analysis for successful EVT (mTICI 2b-3) was performed with HIR alongside demographic and stroke characteristics.
RESULTS: Among 111 patients with M2 MCA occlusion, 23 (21%) had unsuccessful EVT and 88 (79%) had successful EVT. HIR (0.50 [0.00-0.63] versus 0.20 [0.00-0.40], P = .007) and NIHSS score (15 [10-18] versus 10 [7-16], P = .05) were significantly lower in patients with mTICI 2b-3, along with a significantly higher ASPECTS (8 [6-10] versus 9 [8-10], P = .03). In the multivariable logistic regression analysis, higher HIR, representing impaired collateral circulation, was independently associated with lower odds of mTICI 2b-3 (OR per 0.1-unit increase, 0.80; 95% CI, 0.64-0.98; P = .038).
CONCLUSIONS: This retrospective study suggests that HIR may serve as a predictor of success in EVT and a potentially useful adjunct tool for decision-making in patients who have had MeVO stroke. However, the limited sample size and unmeasured confounders should be considered. These findings underscore the role that perfusion imaging-based quantitative collateral assessments can play in prognosis for these patients.
Keywords
Humans, Male, Aged, Middle Aged, Female, Treatment Outcome, Retrospective Studies, Cerebral Angiography, Thrombectomy/methods, Registries, Collateral Circulation, Infarction, Middle Cerebral Artery/surgery, Cerebrovascular Circulation