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Effect of Perforator Territory Infarction on Functional Outcome in Patients With Large Vessel Occlusion
Yasmin Sadigh1,2, Valerie I Vogels1, Pieter Jan van Doormaal3
1Department of Neurosurgery (Y.S., V.I.V., I.S.C.V., D.P., C.M.F.D., R.D., V.V.), Erasmus MC University Medical Center, Rotterdam, the Netherlands.
Stroke
|September 19, 2025
Summary
Ischemia in perforator territories of the brain, following large vessel occlusion in the anterior circulation, is linked to worse functional outcomes at 90 days. Further research is needed to visualize these arteries and improve patient recovery.
Area of Science:
- Neurology
- Neuroimaging
- Stroke Medicine
Background:
- Cerebral perforating arteries' anatomy and ischemic consequences are poorly understood.
- This study investigates perforator territory ischemia's impact on functional outcomes in anterior circulation large vessel occlusion.
Purpose of the Study:
- To evaluate the effect of perforator territory ischemia on functional outcomes in patients with anterior circulation large vessel occlusion.
Main Methods:
- Post hoc analysis of MR CLEAN-MED and MR CLEAN-NO IV trials (Jan 2018-Jan 2021).
- Included patients undergoing endovascular thrombectomy for anterior circulation large vessel occlusion with posttreatment MRI.
- Patients grouped by infarct location: cortex, perforator/insular, or both. Analyzed 24-hour National Institutes of Health Stroke Scale and 90-day modified Rankin Scale.
Main Results:
- 397 of 1167 patients included; median age 71, 51% male.
- Perforator territory ischemia did not significantly affect 24-hour NIHSS but was associated with worse 90-day mRS (OR 2.94).
- Thrombolysis In Cerebral Infarction grade and Heidelberg bleeding classification impacted outcomes.
Conclusions:
- Anterior circulation large vessel occlusion causing perforator territory infarctions predicts unfavorable 90-day functional outcomes.
- Future research should prioritize improved visualization of perforating arteries and understanding their functional anatomy to mitigate ischemia and enhance patient recovery.
