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Hypoperfusion intensity ratio is associated with follow-up infarct volume in medium vessel occlusions: A multicenter

Vivek Yedavalli1, Hamza Adel Salim2, Dhairya Lakhani3

  • 1Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.

Neurotherapeutics : the Journal of the American Society for Experimental Neurotherapeutics
|August 19, 2025
PubMed

Insights

The hypoperfusion intensity ratio (HIR) predicts larger infarct volumes in medium vessel occlusion (MeVO) stroke. This imaging marker may guide treatment and predict outcomes for acute ischemic stroke patients.

Area of Science:

  • Neurology
  • Radiology
  • Cardiovascular Medicine

Background:

  • Medium vessel occlusion (MeVO) is a significant cause of acute ischemic stroke (AIS).
  • Collateral circulation assessment is crucial for predicting stroke progression.
  • The hypoperfusion intensity ratio (HIR) is established for large-vessel occlusions but unstudied in MeVO.

Purpose of the Study:

  • To evaluate the prognostic value of HIR in patients with MeVO.
  • To determine if HIR predicts follow-up infarct volume (FIV) in MeVO.
  • To explore HIR as a potential imaging biomarker for MeVO treatment guidance.

Main Methods:

  • Retrospective, multicenter study of 147 patients with MeVO undergoing mechanical thrombectomy.
  • Pretreatment CT perfusion and follow-up imaging (CT/MRI) at 12-36 hours post-procedure were analyzed.
  • Univariable and multivariable regression models identified predictors of FIV, with HIR as the primary variable.

Main Results:

  • Higher HIR was significantly associated with larger FIV in univariable analysis (β = 80 mL; p < 0.001).
  • After adjusting for confounders, HIR remained an independent predictor of FIV (β = 40 mL; p < 0.001).
  • Tmax >10s volume showed the strongest correlation with FIV (r = 0.56; p < 0.001).

Conclusions:

  • Increased HIR correlates with greater infarct volumes in MeVO.
  • Collateral failure, indicated by HIR, plays a prognostic role in MeVO.
  • HIR is a potential imaging biomarker for guiding treatment and predicting outcomes in MeVO-associated AIS.
Keywords:
Acute Ischemic StrokeCT Perfusion (CTP)Collateral CirculationDistal OcclusionsFollow-Up Infarct Volume (FIV)Hypoperfusion Intensity Ratio (HIR)Mechanical ThrombectomyMedium Vessel Occlusion (MeVO)Stroke OuTmax Thresholds

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