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Current Medical Imaging

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ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

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Research Article

Hypoperfusion Intensity Ratio Correlates with Angiographic Collaterals and Infarct Growth in Acute Stroke with Thrombectomy

Author(s): Zhongping Ai, Liang Jiang, Boxiang Zhao, Haobo Su, Xindao Yin* and Yu-Chen Chen*

Volume 19, Issue 13, 2023

Published on: 14 February, 2023

Article ID: e230123213032 Pages: 9

DOI: 10.2174/1573405619666230123142657

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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.

Graphical Abstract

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