Association Between Hypoperfusion Intensity Ratio and Outcomes After Endovascular Thrombectomy in Posterior Circulation Stroke: A Retrospective Study
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Updated: Nov 4, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Ming Mo1, Chun Rong Tao2, Chun Yu Yu1
1Central Hospital of Dalian University of Technology, Liaoning, China (M.M., C.Y.Y., Z.J.C.).
Background:
The prognostic utility of the hypoperfusion intensity ratio (HIR) in posterior circulation stroke is undefined. We investigated the association between pretreatment HIR and outcomes after mechanical thrombectomy for acute posterior circulation large vessel occlusion.
Methods:
This post hoc analysis of the ATTENTION (Endovascular Treatment for Acute Basilar Artery Occlusion)/ATTENTION-IA (Intra-Arterial Tenecteplase After Successful Endovascular Recanalisation in Patients With Acute Posterior Circulation Arterial Occlusion) trials included patients with posterior circulation occlusion who underwent mechanical thrombectomy and had baseline computed tomography perfusion. HIR (Tmax>10 s/ Tmax>6 s volume) was analyzed. Functional independence (modified Rankin Scale score, 0-2) at 90 days was the primary outcome.
Results:
Among 139 patients, higher HIR (per 0.1 increment) was independently associated with lower odds of 90-day modified Rankin Scale score of 0 to 2 (adjusted odds ratio, 0.643 [95% CI, 0.422-0.979]; P=0.039). However, its discriminative ability was the modest (area under the curve, 0.617 [95% CI, 0.521-0.712]). The established anterior circulation cutoff (HIR<0.4) did not predict outcomes (P=0.115).
Conclusions:
Elevated HIR is independently associated with worse 90-day outcomes after posterior circulation mechanical thrombectomy, but its overall prognostic utility is limited, and the anterior circulation threshold (0.4) could not be validated in this underpowered analysis, highlighting circulation-specific pathophysiological differences.
