Perfusion imaging parameters predict long-term clinical outcome in isolated posterior cerebral artery occlusion stroke patients
BackgroundIsolated posterior cerebral artery (PCA) occlusions, which account for 5% of ischemic strokes, significantly impact patient quality of life due to effects on the thalamus and visual cortex. Current guidelines for acute treatment and the prognostic utility of perfusion imaging in PCA strokes remain limited and underexplored.MethodsWe conducted a retrospective analysis of 21 patients with isolated PCA occlusions from January 2017 to March 2023 at two comprehensive medical institutions. Perfusion imaging parameters, including time-to-maximum (Tmax) > 4 s, Tmax > 6 s, Tmax > 8 s, Tmax > 10 s, and mismatch volume, were extracted. The primary outcome was the modified Rankin Scale (mRS) score at 90 days.ResultsThe median age of patients was 70 years, with 62% being male. Time-to-maximum > 4 s volume (rho = 0.46, 95% CI, 0.1-0.71, <i>p</i> = 0.036) and Tmax > 6 s volume (rho = 0.45, 95% CI, 0.09-0.71, <i>p</i> = 0.04) showed significant positive correlations with 90-day mRS scores. Other perfusion parameters, such as Tmax > 8 s volume and mismatch volume, approached statistical significance, while rCBF and hypoperfusion intensity ratio did not show significant correlations.ConclusionsPerfusion imaging parameters, particularly Tmax tissue volumes, are correlated with long-term clinical outcomes in patients with isolated PCA occlusions. These findings support the potential role of perfusion imaging in the prognostic assessment and management of PCA stroke patients. Future studies with larger cohorts are warranted to confirm these results and to establish standardized perfusion imaging protocols for PCA occlusions.
Authors
- Shenwen Huang (ORCID: https://orcid.org/0000-0003-0636-1133)
- Meisam Hoseinyazdi (ORCID: https://orcid.org/0000-0002-4051-2946)
- Jeremy Josef Heit (ORCID: https://orcid.org/0000-0003-1055-8000)
- Argye E. Hillis (ORCID: https://orcid.org/0000-0002-5192-1171)
- R. Llinás (ORCID: https://orcid.org/0000-0002-9161-2699)
- Jiang Me
- Hanzhang Lu (ORCID: https://orcid.org/0000-0003-3871-1564)
- Gregory W. Albers (ORCID: https://orcid.org/0000-0003-0263-4632)
- Hamza Adel Salim (ORCID: https://orcid.org/0000-0002-5208-8425)
- Dhairya A. Lakhani (ORCID: https://orcid.org/0000-0001-7577-1887)
- Kambiz Nael (ORCID: https://orcid.org/0000-0002-4194-9488)
- Adam Andrew Dmytriw (ORCID: https://orcid.org/0000-0003-0131-5699)
- Francis Deng (ORCID: https://orcid.org/0000-0003-3117-5076)
- Max Wintermark (ORCID: https://orcid.org/0000-0002-6726-3951)
- Aneri Balar (ORCID: https://orcid.org/0000-0002-3592-708X)
- Victor Urrutia (ORCID: https://orcid.org/0000-0002-4995-6949)
- Mona N. Bahouth (ORCID: https://orcid.org/0000-0003-0341-5087)
- Elisabeth B. Marsh (ORCID: https://orcid.org/0000-0002-2385-5074)
- Vivek Srikar Yedavalli (ORCID: https://orcid.org/0000-0002-2450-4014)
- Adrien Guenego (ORCID: https://orcid.org/0000-0001-7281-1652)
- Licia Luna (ORCID: https://orcid.org/0000-0003-3539-4831)
- Nathan Z. Hyson (ORCID: https://orcid.org/0009-0003-2758-3402)
- Tobias D. Faizy
Institutions
- West Virginia University (US)
- St. Michael's Hospital (CA)
- The University of Texas MD Anderson Cancer Center (US)
- Harvard University (US)
- Johns Hopkins University (US)
- University of California, San Francisco (US)
- Erasmus Hospital (BE)
- Johns Hopkins Bayview Medical Center (US)
- University of California System (US)
- Massachusetts General Hospital (US)
- Blanchette Rockefeller Neurosciences Institute (US)
- University Hospital Münster (DE)
- Stanford Medicine (US)
Publication Details
- Journal
- Interventional Neuroradiology
- Published
- 2025-06-17
- DOI
- https://doi.org/10.1177/15910199251342839
- Citations
- 1
- Primary Topic
- Acute Ischemic Stroke Management
- Type
- article
- Field-Weighted Citation Impact
- 1.35