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Updated: Dec 29, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Ischemic Core Volume Combined with the Relative Perfusion Ratio for Stroke Outcome Prediction after Endovascular
Lukas T Rotkopf1, Steffen Tiedt2, Daniel Puhr-Westerheide1
1Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
Insights
A new imaging parameter, perfusion-weighted ischemic core volume (pw-ICV), better predicts stroke outcomes than standard ischemic core volume (ICV) in patients undergoing endovascular thrombectomy (EVT). This can improve patient selection for EVT.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Selecting stroke patients for endovascular thrombectomy (EVT) using imaging is challenging.
- Accurate prediction of morphological and clinical outcomes is crucial for EVT patient selection.
Purpose of the Study:
- To evaluate the combined parameter of ischemic core volume (ICV) and relative cerebral blood flow in the penumbra for predicting outcomes.
- To compare the predictive value of perfusion-weighted ICV (pw-ICV) against standard ICV.
Main Methods:
- Prospective observational study of 221 large vessel occlusion anterior circulation stroke patients undergoing EVT within 6 hours.
- Computed tomography perfusion analyzed using automated algorithms; pw-ICV calculated.
- Functional outcome assessed using modified Rankin Scale (mRS) at 3 months.
Main Results:
- pw-ICV significantly associated with final infarction volume (FIV) (β = .38, P < .001), outperforming ICV.
- pw-ICV showed superior predictive ability for FIV compared to ICV.
- FIV strongly correlated with clinical outcome (mRS ≤ 2) and NIHSS improvement.
Conclusions:
- Perfusion-weighted ICV (pw-ICV) is a superior predictor of morphological and functional outcomes in EVT-treated stroke patients.
- pw-ICV offers improved patient selection for EVT compared to standard ICV.
- This imaging parameter aids in optimizing treatment decisions for acute stroke.
Background And Purpose:
Imaging-based selection of stroke patients for endovascular thrombectomy (EVT) remains an ongoing challenge. Our aim was to determine the value of a combined parameter of ischemic core volume (ICV) and the relative degree of cerebral blood flow in the penumbra for morphologic and clinical outcome prediction.
Methods:
In this Institutional Review Board (IRB)-approved prospective observational study, 221 consecutive patients with large vessel occlusion anterior circulation stroke within 6 hours of symptom onset and subsequent EVT were included between June 2015 and August 2017. Admission computed tomography perfusion was analyzed using automated threshold-based algorithms. Perfusion-weighted ICV (pw-ICV) was calculated by multiplying ICV with the relative cerebral blood flow reduction within the penumbra. Functional outcome was assessed by standardized assessment of the modified Rankin scale (mRS) after 3 months.
Results:
In multivariate analyses, pw-ICV was significantly associated with final infarction volume (FIV) (β = .38, P < .001) after adjustment for penumbra volume, age, sex and time from symptom onset. In separate multivariate analysis with either pw-ICV or ICV, pw-ICV outperformed ICV for the prediction of FIV (Akaike's information criterion: 1,072 vs. 1,089; conditional variable importance: 1,494 vs. 955). There was also a highly significant association between FIV and clinical outcome as measured by an mRS score of 2 or less (odds ratio per 10 mL = .78, P < .001). Both pw-ICV and ICV were significantly associated with NIHSS improvement (both P<.05).
Conclusion:
In EVT-treated stroke patients, pw-ICV outperforms the more commonly used ICV in the prediction of morphological and functional outcome.
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