Journal article
Use of CT perfusion to select patients with medium and distal vessel occlusions for thrombectomy: multicenter retrospective analysis
Journal of neurointerventional surgery
30 Dec 2025
PMID: 41469195
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
BackgroundEarly infarct growth rate (EIGR) provides a dynamic view of stroke progression. Use of CT perfusion (CTP) and EIGR has been thoroughly studied in large vessel occlusions, but not in distal or medium vessel occlusions (MeVOs).ObjectiveWe studied optimal thresholds for EIGR in MeVOs and assessed the use of EIGR and/or the absence of an ischemic core on CTP as practical selection criteria for endovascular thrombectomy (EVT).MethodsThis retrospective analysis included patients receiving CTP for MeVOs before EVT. The primary outcome assessed the ability of EIGR to predict good functional outcomes at 90 days (modified Rankin Scale (mRS) score of 0–2 or back to baseline) using receiver operator characteristic curve analysis. Secondary outcomes evaluated fast and slow progressors based on EIGR for functional outcome at 90 days, excellent reperfusion (thrombolysis in cerebral infarction score ≥2C), procedural complications, and symptomatic intracranial hemorrhage.ResultsAmong 188 patients, 29.2% were fast progressors (EIGR ≥5 mL/hour). Slow progressors had significantly better 90 day mRS outcomes, with higher rates of good functional recovery (58.3%, 95% CI 50.0% to 66.4%; P=0.046). Multivariable analysis confirmed EIGR <5 mL/hour as an independent predictor of favorable outcomes. In posterior or anterior cerebral artery occlusion subgroup analysis, patients with no ischemic core on CTP had higher area under receiver operator characteristic curve (71.9%, 95% CI 54.5% to 89.3% P=0.013), outperforming EIGR thresholds.ConclusionIn this study, EIGR <5 mL/hour was associated with good 90 day outcomes in patients with MeVOs patients, supporting the use of EIGR as a practical selection criterion for EVT.
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Details
- Title
- Use of CT perfusion to select patients with medium and distal vessel occlusions for thrombectomy: multicenter retrospective analysis
- Creators
- Romil Singh - Allegheny Health NetworkHassan A Shakeel - Allegheny Health NetworkNihas Mateti - Allegheny Health NetworkChristopher Todd Hackett - Allegheny Health NetworkSahil Sardana - Allegheny Health NetworkJaylene Cassandra Debiec - Allegheny Health NetworkMuhammad Saim - Allegheny Health NetworkRussell Cerejo - Allegheny Health Network
- Publication Details
- Journal of neurointerventional surgery
- Publisher
- BMJ Publishing Group
- Number of pages
- 6
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Neurology
- Web of Science ID
- WOS:001653989300001
- Scopus ID
- 2-s2.0-105031442907
- Other Identifier
- 991022148105404721
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InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Neuroimaging
- Surgery