Perfusion Imaging to Select Patients with Large Ischemic Core for Mechanical Thrombectomy

Area of Science:

• Neurology
• Radiology
• Interventional Cardiology

Background:

• Mechanical thrombectomy (MT) is often withheld from acute ischemic stroke patients with large infarct cores.
• Perfusion imaging may identify patients with large cores who could still benefit from MT.

Purpose of the Study:

• To test if identifying penumbral tissue with perfusion imaging in patients with large infarct cores translates to better outcomes after MT.
• To evaluate the role of core perfusion mismatch ratio (CPMR) in predicting MT success.

Main Methods:

• Retrospective, multicenter cohort study of 172 adult patients with proximal vessel occlusion and large ischemic cores (≥70 mL).
• Patients received MT or medical care alone.
• Core perfusion mismatch ratio (CPMR) calculated using pre-treatment MRI perfusion.
• Primary outcome: 3-month favorable outcome (modified Rankin Scale 0-3).

Main Results:

• MT was associated with increased likelihood of favorable outcomes and functional independence as CPMR increased.
• A statistically significant benefit of MT was observed for CPMR > 1.72.
• In patients with CPMR > 1.7, MT significantly improved favorable outcomes (aOR, 8.12; 95% CI, 1.24 to 53.11).

Conclusions:

• Core perfusion mismatch ratio (CPMR) identifies a subgroup of acute ischemic stroke patients with large infarct cores who strongly benefit from mechanical thrombectomy.
• Prospective studies are needed to confirm these findings.