Abstract Details

Title The Dynamic Progression of Hyperintensity Ratio as a Marker of Cerebral Autoregulatory Failure in Large Vessel Occlusion Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S60 - Cerebrovascular Imaging and Biomarkers (2:00 PM-2:12 PM)

Poster/Presentation
Number 006

Objective To Evaluate correlation between HI Ratio, infarct core and time.

Background Hypoperfusion Intensity Ratio (HIR) has been suggested as a surrogate marker of collateral blood flow in the setting of large vessel occlusion (LVO) stroke. The temporal relation of HIR with core is yet to be determined.

Design/Methods All patients with LVO stroke who underwent CTP imaging presenting within 24 hours from symptom onset at our institution were retrospectively included over a period of 12 months. Patient demographics, clinical and imaging variable and last seen normal (LSN) to imaging onset were collected. Correlation between core size, HIR and time from LSN were analyzed. Patients were stratified based on infarct core growth rate in to three profiles: slow (<2 cc/hr), moderate (2-10 cc/hr) and fast (>10 cc/hr) growers.

Results A total of 109 patients were identified with median age of 81 (IR 65-88), NIHSS of 16 (11-21) and median time from LSN to CTP of 406 minutes (IQR 204-714). Two-thirds of our patients (n=73) presented with small core size (defined as <20 cc) distributed over 24 hours. A linear relationship was observed between HIR and time with a concordant distribution of slow, moderate and fast core growth rates. However, there was no linear correlation between core size and time.

Conclusions

HI Ratio is possibly a surrogate marker for collateral flow at a certain point in time, however, the non-linear relationship of HI Ratio and core size is suggestive of dynamic variation in HIR over time. Moreover, other factors such as time in poor HIR profile may represent a point of auto-regulatory failure and subsequent ischemic growth. Further study with a larger sample size would be indicated to simulate the dynamic progression in all patient profiles to better understand this relationship.

Authors/Disclosures
Karan Tarasaria, MBBS PRESENTER	Dr. Tarasaria has nothing to disclose.
Amre Nouh, MD, FAAN (Cleveland Clinic)	Dr. Nouh has stock in Openwater.

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