Key result
Lower hypoperfusion intensity ratio and Tmax mismatch ratios were independently associated with atherosclerotic ICA lesions before endovascular therapy.
Why the study?
The role of perfusion imaging in identifying the etiology of extracranial ICA lesions before endovascular therapy remains underexplored.
Do CT perfusion parameters (HIR and Tmax mismatch ratios) identify atherosclerotic etiology in patients with acute ischemic stroke and ≥70% extracranial ICA stenosis prior to endovascular therapy?
Cohort
No
Do CT perfusion parameters (HIR and Tmax mismatch ratios) identify atherosclerotic etiology in patients with acute ischemic stroke and ≥70% extracranial ICA stenosis prior to endovascular therapy?
Lower hypoperfusion intensity ratio and Tmax mismatch ratios on CT perfusion imaging can help identify atherosclerotic etiology in acute steno-occlusive carotid artery disease prior to endovascular therapy.
Answers are grounded in this paper and cite their sources.
May support perfusion-based etiology differentiation in acute ICA stenosis; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND AND PURPOSE: Perfusion imaging is commonly utilized to assess collateral status in patients with acute ischemic stroke due to anterior large-vessel occlusion. However, its potential role in identifying the etiology of extracranial ICA lesions before endovascular therapy (EVT) remains underexplored. We aimed to evaluate the utility of perfusion imaging parameters-particularly the hypoperfusion intensity ratio (HIR)-in detecting extracranial ICA steno-occlusion caused by atherosclerotic disease before EVT. MATERIALS AND METHODS: We conducted a retrospective cohort study of patients with consecutive EVT stroke in our institutional registry from January 2019 to December 2022 who underwent CT perfusion imaging and had ≥70% extracranial ICA stenosis. Patients were categorized into those with atherosclerotic and nonatherosclerotic ICA based on clinical and radiologic characteristics. Perfusion parameters, including CBF, CBV, time-to-maximum (Tmax), and Tmax mismatch ratios, were compared between groups. Multivariable logistic regression was performed to identify independent predictors of atherosclerotic disease. In multivariable analysis, lower HIR (adjusted OR 0.01; 95% CI: 0.00-0,16) and several Tmax mismatch ratios, including >10 seconds/>8 seconds (adjusted OR 0.05; 95% CI: 0.00-0.53), >10 seconds/>4 seconds (adjusted OR 0.01; 95% CI: 0.00-0.26), >8 seconds/>6 seconds (adjusted OR 0.04; 95% CI: 0.00-0.58), and >8 seconds/>4 seconds (adjusted OR 0.04; 95% CI: 0.00-0.86), were independently associated with atherosclerotic ICA lesions. CONCLUSIONS: HIR and Tmax mismatch ratios (>10 seconds/>8 seconds, >10 seconds/4 seconds, >8 seconds/6 seconds, >8 seconds/4 seconds) were associated with acute steno-occlusive ICA due to atherosclerotic disease before EVT. Early identification of the underlying etiology may facilitate a more tailored cervical approach during endovascular treatment.
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Quispe-Orozco et al. (2026) conducted a cohort in Acute ischemic stroke due to anterior large-vessel occlusion with ≥70% extracranial ICA stenosis. Lower hypoperfusion intensity ratio (HIR) and Tmax mismatch ratios was evaluated on Atherosclerotic ICA lesions (OR 0.01, 95% CI 0.00-0.16, p=<0.01). Lower hypoperfusion intensity ratio and Tmax mismatch ratios were independently associated with atherosclerotic ICA lesions before endovascular therapy.
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