Hypoperfusion Intensity Ratio Predicts Malignant Edema and Functional Outcome in Large-Vessel Occlusive Stroke with...

Area of Science:

• Neurology
• Stroke Medicine
• Neuroimaging

Background:

• Malignant cerebral edema (MCE) is a severe complication of acute ischemic stroke, particularly with large infarcts or incomplete revascularization.
• Predictors of MCE in patients with smaller infarcts and moderate-to-large tissue-at-risk after endovascular thrombectomy (ET) are not well-defined.
• Understanding these predictors is crucial for managing stroke patients who undergo ET but do not achieve complete reperfusion.

Purpose of the Study:

• To identify predictors of MCE in patients with anterior circulation large vessel occlusion (LVO) and a small ischemic core (<80 mL) who undergo unsuccessful endovascular thrombectomy (ET).
• To evaluate the association between identified predictors and 90-day functional outcomes.

Main Methods:

• Retrospective review of a stroke registry including patients with unsuccessful revascularization (mTICI 0-2a) after ET.
• Inclusion criteria: ischemic core <80 mL, Tmax >6s volume ≥80 mL, mismatch ratio ≥1.8, and anterior circulation LVO.
• MCE defined as ≥5 mm midline shift on follow-up imaging; functional outcome assessed by modified Rankin Scale (mRS) at 90 days.

Main Results:

• Thirty-six patients met the criteria. Younger age, higher systolic blood pressure, larger core infarct volume, and higher hypoperfusion intensity ratio (HIR) were associated with MCE.
• Multivariate analysis identified age, HIR, and core infarct volume as independent predictors of MCE.
• An optimal HIR threshold of ≥0.54 predicted MCE (OR 14.7) and poor 3-month functional outcome (mRS 3-6, OR 10.8).

Conclusions:

• Younger age, larger core infarct volume, and higher HIR are significant predictors of MCE in stroke patients with anterior circulation LVO and suboptimal revascularization.
• The hypoperfusion intensity ratio (HIR) is a key predictor of both MCE development and poor functional outcomes at 90 days.
• These findings highlight the importance of HIR in risk stratification and management planning for this patient cohort.