Title:Hypoperfusion Intensity Ratio Correlates with Angiographic Collaterals
and Infarct Growth in Acute Stroke with Thrombectomy
Volume: 19
Author(s): Zhongping Ai, Liang Jiang, Boxiang Zhao, Haobo Su, Xindao Yin*Yu-Chen Chen*
Affiliation:
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68, Changle Road, Nanjing
210006, China
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68, Changle Road, Nanjing
210006, China
Keywords:
Stroke, perfusion-weighted imaging, collateral circulation, thrombectomy, angiographic collaterals, ischemic stroke.
Abstract:
Background: The assessment of collaterals before endovascular thrombectomy (EVT) therapy
play a pivotal role in clinical decision-making for acute stroke patients.
Objective: To investigate the correlation between hypoperfusion intensity ratio (HIR), collaterals on
digital subtraction angiography (DSA), and infarct growth in acute stroke patients who underwent EVT
therapy.
Methods: Patients with acute ischemic stroke (AIS) who underwent EVT therapy were enrolled retrospectively.
HIR was assessed through magnetic resonance imaging (MRI) and was defined as the
Tmax > 10 s lesion volume divided by the Tmax > 6 s lesion volume. Collaterals were assessed on
DSA using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional
Radiology (ASITN/SIR) scale. Good collaterals were defined as ASITN/SIR score 3–4 and
poor collaterals were defined as ASITN/SIR score 0–2. Spearman’s rank correlation analysis was used
to evaluate the correlation between HIR, collaterals, infarct growth, and functional outcome.
Results: A total of 115 patients were included. Patients with good collateral (n = 59) had smaller HIR
(0.29 ± 0.07 vs. 0.52 ± 0.14; t = 10.769, P < 0.001) and infarct growth (8.47 ± 2.40 vs. 14.37 ± 5.28; t =
7.652, P < 0.001) than those with poor collateral (n = 56).
Discussion: The ROC analyses showed that the optimal cut-off value of HIR was 0.40, and the sensitivity
and specificity for predicting good collateral were 85.70% and 96.61%, respectively. With the
optimal cut-off value, patients with HIR < 0.4 (n = 67) had smaller infarct growth (8.86 ± 2.59 vs.
14.81 ± 5.52; t = 6.944, P < 0.001) than those with HIR ≥ 0.4 (n = 48). Spearman’s rank correlation
analysis showed that HIR had a correlation with ASITN/SIR score (r = -0.761, P < 0.001), infarct
growth (r = 0.567, P < 0.001), and mRS at 3 months (r = -0.627, P < 0.001).
Conclusion: HIR < 0.4 is significantly correlated with good collateral status and small infarct growth.
Evaluating HIR before treatment may be useful for guiding EVT and predicting the functional outcome
of AIS patients.
