Abstract Details

Title Hypoperfusion Intensity Ratio May Predict Cerebral Edema After Endovascular Thrombectomy

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P14 - Poster Session 14 (11:45 AM-12:45 PM)

Poster/Presentation
Number 13-009

Objective To evaluate the relationship between hypoperfusion intensity ratio and outcomes in patients with acute ischemic stroke due to large vessel occlusion who underwent successful endovascular thrombectomy.

Background The Hypoperfusion intensity ratio (HIR) is a surrogate of collateral measurement within oligemic tissue in anterior circulation large vessel occlusion (LVO). HIR is easily calculated using RAPID software output of CT perfusion imaging. Studies have shown that lower pre-treatment HIR is associated with better functional outcomes after endovascular thrombectomy (ET) for acute ischemic stroke (AIS). Typically, HIR is calculated using Tmax>6 /Tmax>10, however an alternative calculation using Tmax>4/Tmax>10 may be more inclusive and a better estimate of tissue at risk.

Design/Methods A retrospective chart and imaging review of 282 patients with AIS evaluated for ET between January 2015 and July 2020 was conducted. 53 patients met inclusion criteria of LVO with pre-treatment CT perfusion imaging analyzed using RAPID software and successful reperfusion (TICI2b and TICI3). The HIR was calculated in 44 of these patients, using two measurement methods; Tmax >6/Tmax>10 or the traditional method, and an alternative method with Tmax>4/Tmax>10. Data including baseline NIHSS, baseline mRS, initial ASPECT score, post-treatment development of hemorrhagic transformation (HT), cerebral edema (CE), mRS on discharge and at 90 day were collected.

Results After adjusting for baseline ASPECT score, NIHSS, and mRS, neither the traditional nor alternative HIR were predictors for outcome with mRS at discharge (p=0.85 p=0.81) or at 90-day (p=0.86, p=0.47). HIR was not different amongst patients who developed HT (p=0.38, p=0.37). A high HIR was associated with development of CE when calculated with the alternative method (0.35 vs. 0.19, p=0.006).

Conclusions HIR did not predict outcome in patients with AIS and LVO undergoing ET. High HIR using the alternative calculation was associated with increased likelihood of developing CE after successful reperfusion.

Authors/Disclosures
Caitlin Radnis, MD (Rush University Medical Center) PRESENTER	Dr. Radnis has nothing to disclose.
	No disclosure on file
Rima Dafer, MD (Rush University Medical Center)	Dr. Dafer has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli Lilly. Dr. Dafer has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Eli Lilly. Dr. Dafer has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Anderson, Rasor, and partners.

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