ABSTRACT NUMBER: ESOC2026A217 HYPOPERFUSION INTENSITY RATIO MAY NOT BE A GOOD PREDICTOR OF FUNCTIONAL OUTCOME IN ANTERIOR CIRCULATION LARGE VESSEL OCCLUSION STROKE WHEN ADJUSTING FOR MULTIPLE COVARIATES

Abstract Background and aims A higher hypoperfusion intensity ratio (HIR) on CT perfusion imaging (CTP) for anterior circulation large vessel occlusion stroke (LVO) is associated with poor functional outcome at 90 days. We aimed to examine whether this association holds when controlling for multiple baseline risk factors, clinical characteristics of stroke, occlusion location and laterality and identify relevant predictors. Methods This was a single center retrospective study. Clinical data were obtained from electronic medical records. Alberta Stroke programme early CT score (ASPECTS) scores, final infarct volumes were independently calculated. Mann-Whitney U, Chi-squared, independent t-tests were used to compare continuous and discrete variables. Multivariate logistic regression was conducted with HIR to determine predictors of 90-day-mRS outcome. Results Total 83 records available for analysis, 65% underwent EVT, 49% achieved mRS ≤2 at 90 days. Median age 68 (IQR 60-78). Patients with good functional outcome were less likely to have a prior stroke (7.3% vs. 3.8%; p=0.039), and more likely to have lower HbA1c (median 5.7 vs. 6.0; p=0.025), higher ASPECTS score (median 8 vs. 7; p=0.004). Patients with poor outcome tended to have infarct in both cortical and subcortical locations (90.5% vs. 65.8%; p=0.025). Multivariate logistic regression controlling for potential covariates revealed HIR was a poor predictor of functional outcome, however higher Tmax > 6s (OR 1.03; p=0.026) predicted 90-day functional independence. Conclusions CT ASPECTS score and ischemic penumbra volume may be better predictors of functional outcomes in anterior circulation LVO compared to HIR. Overreliance on HIR for prognostication prior to EVT may not be ideal. Conflict of interest Ameya Kale: nothing to disclose. Srinath Ramanan: nothing to disclose. Pooja Jethwani: nothing to disclose. Melisha Budhathoki: nothing to disclose. Anvesh Balabhadra: nothing to disclose. Syed Daniyal Asad: nothing to disclose Table 1 - belongs to Methods Table 2 - belongs to Results Figure 1 - belongs to Conclusions