Evidence map›Paper›PMID 37196564›Full record

Observational studyJournal of stroke and cerebrovascular diseases : the official journal of National Stroke Association2023

Elevated Hypoperfusion Intensity Ratio (HIR) observed in patients with a large vessel occlusion (LVO) presenting in the evening.

Anirudh Sreekrishnan, Pierre Seners, Nicole Yuen, Jean-Marc Olivot, Michael Mlynash, Maarten G Lansberg, Jeremy J Heit, Sarah Lee, Patrik Michel, Davide Strambo and 4 more

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Review
  2. Article
  3. Hypoperfusion intensity ratio is associated with follow-up infarct volume in medium vessel occlusions: A multicenter multinational study.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2025
    Article
  4. Article
  5. Article
  6. Larger ischemic cores and poor collaterals among large vessel occlusions presenting in the late evening.Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association · 2023
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Anirudh SreekrishnanDepartment of Neurology, Stanford Hospital, Palo Alto, CA, USA. Electronic address: asreekri@stanford.edu.
Pierre SenersDepartment of Neurology, Stanford Hospital, Palo Alto, CA, USA; Neurology Department, Hôpital Fondation A. de Rothschild, Paris, France; Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Paris, France.
Nicole YuenDepartment of Neurology, Stanford Hospital, Palo Alto, CA, USA.
Jean-Marc OlivotDepartment of Neurology and UMR Clinical investigating Center 1436 Centre Hospitalier Hospitalier Universitaire de Toulouse, Toulouse, France.
Michael MlynashDepartment of Neurology, Stanford Hospital, Palo Alto, CA, USA.
Maarten G LansbergDepartment of Neurology, Stanford Hospital, Palo Alto, CA, USA.
Jeremy J HeitDepartment of Neurosurgery, Stanford Hospital, Palo Alto, CA, USA.
Sarah LeeDepartment of Neurology, Stanford Hospital, Palo Alto, CA, USA.
Patrik MichelDepartment of Neurology, Lausanne University Hospital, Lausanne, Switzerland.
Davide StramboDepartment of Neurology, Lausanne University Hospital, Lausanne, Switzerland.
Alexander SalernoDepartment of Neurology, Lausanne University Hospital, Lausanne, Switzerland.
José Bernardo Escribano ParedesDepartment of Neurology, Geneva University Hospital, Geneva, Switzerland.
Emmanuel CarreraDepartment of Neurology, Geneva University Hospital, Geneva, Switzerland.
Gregory W AlbersDepartment of Neurology, Stanford Hospital, Palo Alto, CA, USA.

Funding

Stanford University Regional Coordinating Stroke Center for the NIH Stroke Trials NetworkU24NS107220 · NINDS · STANFORD UNIVERSITY · PI MAARTEN G LANSBERG · 2018 to 2026
$2.8M
NINDS NIH HHS U24 NS107220
6 · The paper itself

Abstract

backgroundCircadian variability has been implicated in timing of stroke onset, yet the full impact of underlying biological rhythms on acute stroke perfusion patterns is not known. We aimed to describe the relationship between time of stroke onset and perfusion profiles in patients with large vessel occlusion (LVO).

methodsA retrospective observational study was conducted using prospective registries of four stroke centers across North America and Europe with systematic use of perfusion imaging in clinical care. Included patients had stroke due to ICA, M1 or M2 occlusion and baseline perfusion imaging performed within 24h from last-seen-well (LSW). Stroke onset was divided into eight hour intervals: (1) Night: 23:00-6:59, (2) Day: 7:00-14:59, (3) Evening: 15:00-22:59. Core volume was estimated on CT perfusion (rCBF <30%) or DWI-MRI (ADC <620) and the collateral circulation was estimated with the Hypoperfusion Intensity Ratio (HIR = [Tmax>10s]/[Tmax>6s]). Non-parametric testing was conducted using SPSS to account for the non-normalized dependent variables.

resultsA total of 1506 cases were included (median age 74.9 years, IQR 63.0-84.0). Median NIHSS, core volumes, and HIR were 14.0 (IQR 8.0-20.0), 13.0mL (IQR 0.0-42.0), and 0.4 (IQR 0.2-0.6) respectively. Most strokes occurred during the Day (n = 666, 44.2%), compared to Night (n = 360, 23.9%), and Evening (n = 480, 31.9%). HIR was highest, indicating worse collaterals, in the Evening compared to the other timepoints (p = 0.006). Controlling for age and time to imaging, Evening strokes had significantly higher HIR compared to Day (p = 0.013).

conclusionOur retrospective analysis suggests that HIR is significantly higher in the evening, indicating poorer collateral activation which may lead to larger core volumes in these patients.

Indexed as

StrokeAgedAged, 80 and overCollateral CirculationEuropeHumansMiddle AgedRetrospective StudiesAcute strokeCircadian rhythmImagingLarge vessel occlusion

Identifiers

PMID37196564
PMCPMC10524823

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.