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Updated: Aug 11, 2026
A Fibrin-Enriched and tPA-Sensitive Photothrombotic Stroke Model
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.
Purpose:
Outcomes remain heterogeneous after angiographically successful endovascular thrombectomy (EVT), and pretreatment perfusion-collateral status may contribute to this variability. We evaluated whether the Perfusion Collateral Impairment Score (PCIS), a composite of hypoperfusion intensity ratio, cerebral blood volume index, and prolonged venous transit, was associated with 90-day functional outcome across mTICI reperfusion groups after EVT.
Methods:
This retrospective secondary analysis included patients from 2 hospitals with ICA, M1, or M2 occlusion who underwent EVT and had available pretreatment CT perfusion, PCIS, final mTICI grade, and valid 90-day modified Rankin Scale (mRS). PCIS was dichotomized as low burden (0-1) versus high burden (2-3), and successful reperfusion was defined as mTICI 2b-3. The primary outcome was 90-day mRS 0-2. Multivariable logistic regression among patients with mTICI 2b-3 adjusted for age, continuous admission NIHSS, ASPECTS, intravenous thrombolysis, admission glucose, occlusion site, and mTICI 2b versus 2c-3. Prespecified NIHSS-threshold, ordinal PCIS, component, and model-performance analyses were also performed.
Results:
Among 194 patients, 172 achieved mTICI 2b-3 reperfusion. Favorable outcome occurred in 63/108 patients (58.3%) with PCIS 0-1 versus 27/64 (42.2%) with PCIS 2-3. In the primary model using continuous NIHSS, high PCIS burden was associated with lower odds of favorable outcome, although the confidence interval crossed unity (adjusted OR, 0.56; 95% CI, 0.25-1.25; p=.16). In the prespecified NIHSS >5 model, high PCIS burden remained independently associated with lower odds of favorable outcome (adjusted OR, 0.44; 95% CI, 0.20-0.94; p=.04). Each 1-point increase in ordinal PCIS was associated with lower odds of favorable outcome (adjusted OR, 0.67; 95% CI, 0.45-0.99; p=.05), with improved model fit (likelihood-ratio p=.04). PVT was the only independently associated component (adjusted OR, 0.44; 95% CI, 0.20-0.95; p=.04).
Conclusions:
Pretreatment PCIS identified clinically meaningful outcome heterogeneity after EVT. High PCIS burden remained independently associated with unfavorable outcome in the prespecified NIHSS >5 model, while ordinal PCIS demonstrated a graded relationship with outcome and improved model fit. These findings support PCIS as a complementary pretreatment risk-stratification marker after successful reperfusion.
