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. 2024 Oct;54(10):e14264.
doi: 10.1111/eci.14264. Epub 2024 Jun 10.

Hypoperfusion intensity ratio correlates with collaterals and predicts outcome and infarct volume in acute ischemic stroke patients

Giorgio Busto  1 , Andrea Morotti  2 , Ilaria Casetta  3 , Angelo Barra  4 , Alessandro Fiorenza  1 , Francesca Di Pasquale  1 , Maria Giulia Maccaglia  5 , Maddalena Toffali  2 , Sara Mancini  1 , Edoardo Carlesi  1 , Vanessa Palumbo  6 , Ivano Lombardo  1 , Alessandro Padovani  2 , Enrico Fainardi  7
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Hypoperfusion intensity ratio correlates with collaterals and predicts outcome and infarct volume in acute ischemic stroke patients

Giorgio Busto et al. Eur J Clin Invest. 2024 Oct.

Abstract

Background: Hypoperfusion Intensity Ratio (HIR) is associated with collaterals and outcome in acute ischemic stroke (AIS). We investigated whether a combined assessment of HIR and collaterals could provide an added value.

Methods: Retrospective single-center study, including AIS patients with large vessel occlusion and endovascular treatment 0-24 h from onset. Predictors of FIV and outcome (90 days modified Rankin Scale 0-1) were investigated with linear and logistic regression respectively. Subjects were stratified in three groups: poor collaterals (grade 0-3) with poor HIR (≥.4), good collaterals (grade 4-5) with poor HIR/poor collaterals with good HIR (<.4) and good collaterals with good HIR.

Results: We included 337 patients (median age 77, 53.1% males), of whom 100 (29.7%) had excellent outcome. One hundred and forty five patients with favourable collateral and HIR profiles had smaller infarct (median poor collaterals with poor HIR 41 mL, good collaterals with poor HIR/poor collaterals with good HIR 21 mL and good collaterals with good HIR 11 mL, p <.001) and higher rates of excellent outcome (poor collaterals with poor HIR 15.7%, good collaterals with poor HIR/poor collaterals with good HIR 26.2% and good collaterals with good HIR 39.3% p =.001). Logistic regression showed that patients with favourable collateral and HIR profiles had the highest odds of good outcome (OR: 3.83, 95% CI 1.62-9.08, p =.002).

Conclusion: Collaterals and HIR are independent predictors of final infarct lesion and outcome in stroke patients and their integration provides an added value. These findings might inform clinical practice and future trials.

Keywords: CT perfusion; acute ischemic stroke; collaterals; hypoperfusion intensity ratio; infarct volume; multiphase CT angiography.

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References

REFERENCES

    1. Campbell BCV , Khatri P . Stroke. Stroke Lancet. 2020;396:129‐142.
    1. Shafie M , Yu W . Recanalization therapy for acute ischemic stroke with large vessel occlusion: where we are and what comes next? Transl Stroke Res. 2021;12:369‐381.
    1. Papanagiotou P , Ntaios G . Endovascular thrombectomy in acute ischemic stroke. Circ Cardiovasc Interv. 2018;11:e005362.
    1. Maguida G , Shuaib A . Collateral circulation in ischemic stroke: an updated review. J Stroke. 2023;25:179‐198.
    1. Uniken Venema SM , Dankbaar JW , van der Lugt A , Dippel DWJ , van der Worp HB . Cerebral collateral circulation in the era of reperfusion therapies for acute ischemic stroke. Stroke. 2022;53:3222‐32343.

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