Evaluating the prognostic impact of hypoperfusion intensity ratio in acute ischemic stroke patients undergoing early-phase endovascular thrombectomy

This research aimed to assess the prognostic relevance of the hypoperfusion intensity ratio (HIR) concerning 90-day outcomes in patients with acute ischemic stroke (AIS) managed within the early intervention window. A retrospective review was conducted on AIS patients who received pretreatment computed tomography perfusion imaging and endovascular thrombectomy due to large vessel occlusions in the anterior circulation between January 2020 and September 2022. Clinical data, including the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) from non-contrast CT, along with perfusion metrics such as ischemic core, hypoperfusion extent, core-penumbra mismatch, and HIR, were analyzed. Patients were divided into groups with favorable (modified Rankin Scale score 0-2) and unfavorable outcomes (modified Rankin Scale score 3-6). Among the 187 patients evaluated, 95 (50.8%) had favorable outcomes. Univariate analysis showed significant associations between functional outcomes and variables like age, National Institutes of Health Stroke Scale score at admission, ASPECTS, HIR, ischemic core volume, and hypoperfusion volume (P < .05). Multivariate analysis revealed that younger age (odds ratio [OR] 1.064; 95% confidence interval [CI] 1.025-1.106, P = .001), lower National Institutes of Health Stroke Scale score at admission (OR 1.116; 95% CI 1.038-1.199, P = .003), smaller ischemic core volume (OR 1.017; 95% CI 1.002-1.033, P = .029), higher ASPECTS (OR 0.800; 95% CI 0.662-0.967, P = .021), and reduced HIR (OR 1.516; 95% CI 1.230-1.869, P = .001) independently predicted favorable outcomes at 90 days. Lower HIR was independently linked to improved functional outcomes in AIS patients receiving endovascular thrombectomy within the early intervention timeframe.