Evidence map›Paper›PMID 39373942›Full record

ArticleClinical neuroradiology2025

High Hypoperfusion Intensity Ratio Is Independently Associated with Very Poor Outcomes in Large Ischemic Core Stroke.

Vivek Yedavalli, Hamza Adel Salim, Dhairya A Lakhani, Aneri Balar, Janet Mei, Licia Luna, Francis Deng, Nathan Z Hyson, Jens Fiehler, Paul Stracke and 6 more

Abstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in Clinical neuroradiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing 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

7 citing papers in PubMed.

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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

16 authors.

Vivek YedavalliDepartment of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA. vyedava1@jhmi.edu.
Hamza Adel SalimDepartment of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.
Dhairya A LakhaniDepartment of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.
Aneri BalarDepartment of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.
Janet MeiDepartment of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.
Licia LunaDepartment of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.
Francis DengDepartment of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.
Nathan Z HysonDepartment of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.
Jens FiehlerDepartment of Radiology, Neuroendovascular Program, University Medical Center Hamburg, Hamburg, Germany.
Paul StrackeDepartment of Radiology, Neuroendovascular Program, University Medical Center Münster, Münster, Germany.
Gabriel BroocksDepartment of Radiology, Neuroendovascular Program, University Medical Center Hamburg, Hamburg, Germany.
Christian HeitkampDepartment of Radiology, Neuroendovascular Program, University Medical Center Hamburg, Hamburg, Germany.
Gregory W AlbersDepartment of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA.
Max WintermarkDepartment of Neuroradiology, MD Anderson Medical Center, 77030, Houston, TX, USA.
Tobias D FaizyDepartment of Radiology, Neuroendovascular Program, University Medical Center Münster, Münster, Germany.
Jeremy J HeitDepartment of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundRecent advances have highlighted the efficacy of endovascular thrombectomy (EVT) in patients with large ischemic core stroke, yet a significant portion still experience very poor outcomes, defined as a 90-day modified Rankin Score (mRS) of 5-6. This study aims to investigate the hypoperfusion intensity ratio (HIR) as a prognostic imaging parameter for these outcomes.

methodsIn a multicenter retrospective cohort study, data from consecutive patients undergoing EVT for acute ischemic stroke with large vessel occlusion (AIS-LVO) at two comprehensive stroke centers were analyzed. The study included patients with an Alberta Stroke Program Early CT Score (ASPECTS) of 5 or less and utilized pretreatment perfusion imaging to calculate HIR. The primary outcome was very poor outcomes (90 days mRS 5-6).

resultsAmong 102 patients included, 59 (57.8%) had very poor outcome (90 days mRS 5-6). Multivariable logistic regression analysis adjusting for multiple covariates including admission National Institutes of Health Stroke Scale (NIHSS) and EVT revealed that higher admission NIHSS (adjusted odds ratio [aOR] 1.224, 95% CI 1.089-1.374, p = 0.001) and HIR (aOR per 0.1 incremental change, 1.34, 95% CI 1.02-1.82, P = 0.042) were independently associated with very poor outcomes.

conclusionThis study demonstrates that admission NIHSS and HIR are independently associated with very poor outcome (90 days mRS 5-6) in patients with large ischemic core strokes. These findings highlight the importance of collateral status and perfusion imaging in predicting outcomes in this patient population, suggesting a potential role for HIR in the triage and management of large core stroke patients.

Indexed as

Ischemic StrokeThrombectomyAgedAged, 80 and overCerebrovascular CirculationEndovascular ProceduresFemaleHumansMaleMiddle AgedPrognosisRetrospective StudiesTomography, X-Ray ComputedTreatment Outcome

Identifiers

PMID39373942

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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.