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Published on: June 4, 2021
Pretreatment Perfusion-Collateral Impairment Identifies Outcome Heterogeneity After Thrombectomy Reperfusion
Derek A Tsang1, Mona Gad1, Karthik Lalwani1
1From the Department of Radiology (D.A.T., M.G., K.L., V.S.Y.), Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA; Department of Neuroradiology (H.A.S.), MD Anderson Medical Center, Houston, TX, USA; Department of Neuroradiology (D.A.L.), Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA and University of Cincinnati Medical Center (A.S.), Cincinnati, Ohio.
The Perfusion Collateral Impairment Score (PCIS) helps predict outcomes after endovascular thrombectomy (EVT). A higher PCIS indicates a greater risk of unfavorable outcomes, aiding in patient risk stratification.
Area of Science:
- Neurology
- Interventional Radiology
- Medical Imaging
Background:
- Outcomes after endovascular thrombectomy (EVT) for acute ischemic stroke are variable.
- Pretreatment perfusion and collateral status may influence patient outcomes.
- The Perfusion Collateral Impairment Score (PCIS) is a composite measure assessing these factors.
Purpose of the Study:
- To evaluate the association between the Perfusion Collateral Impairment Score (PCIS) and 90-day functional outcomes after EVT.
- To determine if PCIS can help explain outcome heterogeneity across different reperfusion grades (mTICI).
Main Methods:
- Retrospective analysis of 194 patients undergoing EVT for ICA, M1, or M2 occlusions.
- Utilized pretreatment CT perfusion data to calculate PCIS.
- Assessed 90-day modified Rankin Scale (mRS) scores and correlated them with PCIS burden (low vs. high) and ordinal scores.
- Multivariable logistic regression adjusted for key clinical and imaging variables.
Main Results:
- Among 172 patients with successful reperfusion (mTICI 2b-3), 58.3% with low PCIS (0-1) had favorable outcomes versus 42.2% with high PCIS (2-3).
- High PCIS burden was independently associated with lower odds of favorable outcome in the NIHSS >5 subgroup (aOR, 0.44; P=.04).
- Each 1-point increase in ordinal PCIS was associated with lower odds of favorable outcome (aOR, 0.67; P=.05), and prolonged venous transit (PVT) was the only independently associated component.
Conclusions:
- Pretreatment PCIS effectively identifies patients with heterogeneous outcomes after successful EVT.
- High PCIS burden is linked to unfavorable outcomes, particularly in patients with higher NIHSS scores.
- PCIS serves as a valuable tool for pretreatment risk stratification in patients undergoing EVT.
