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Updated: Sep 30, 2025
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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
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How to Define Fast and Slow Progressors in Any-Type Occlusion Acute Ischemic Stroke
Ali Z Nomani1,2, Jeremy L Rempel3, Khurshid A Khan1
1Department of Medicine, Division of Neurology, University of Alberta, Edmonton, Alberta, Canada.
Summary
The hypoperfusion index (HI) effectively identifies acute ischemic stroke progression rates in all patients, unlike traditional methods. This tool aids in determining reperfusion eligibility and predicting clinical outcomes.
Area of Science:
- Neurology
- Radiology
- Biomedical Engineering
Background:
- Assessing infarct progression in acute ischemic stroke is challenging due to time and core constraints with existing methods.
- Variable thresholds exclude many patients, limiting timely treatment decisions.
Purpose of the Study:
- To compare traditional infarct progression thresholds with the hypoperfusion index (HI).
- To evaluate the performance of HI in categorizing patients with fast versus slow infarct progression.
- To assess HI's utility in predicting reperfusion eligibility and clinical outcomes.
Main Methods:
- Analysis of 106 acute ischemic stroke patients with any-type occlusion.
- Comparison of infarct progression rates using various core and time-based criteria.
- Evaluation of the hypoperfusion index (HI) for classifying progression speed.
Main Results:
- Traditional methods inconsistently classified infarct progression, with significant patient exclusion.
- The hypoperfusion index (HI) successfully categorized 100% of patients (n=106) with an optimal cutoff of 0.5.
- HI demonstrated high diagnostic performance (sensitivity/specificity 100%/91%, AUC 0.94) and correlated with improved clinical outcomes (mRS 2 vs 5).
Conclusions:
- The hypoperfusion index (HI) offers a comprehensive method for assessing infarct progression in acute ischemic stroke.
- HI shows promise for identifying patients eligible for reperfusion therapy and predicting outcomes.
- External validation is recommended for the hypoperfusion index (HI).
