TY - JOUR
T1 - Hypoperfusion Intensity Ratio Predicts Successful Recanalization in M2 MCA Occlusion Stroke Treated with Thrombectomy
AU - MAD MT Investigators
AU - MAD-MT Consortium
AU - Salim, Hamza Adel
AU - Kooshki, Alireza
AU - Lakhani, Dhairya A.
AU - Hoseinyazdi, Meisam
AU - Faizy, Tobias D.
AU - Heit, Jeremy J.
AU - Liebeskind, David S.
AU - Mei, Janet
AU - Wolman, Dylan
AU - Albers, Gregory W.
AU - Sriwastwa, Aakanksha
AU - Cho, Andrew
AU - Guenego, Adrien
AU - Dmytriw, Adam A.
AU - Yedavalli, Vivek S.
AU - Essibayi, Muhammed Amir
AU - Musmar, Basel
AU - Adeeb, Nimer
AU - Simonato, Davide
AU - Li, Yan Lin
AU - Henninger, Nils
AU - Sundararajan, Sri Hari
AU - Kühn, Anna Luisa
AU - Khalife, Jane
AU - Ghozy, Sherief
AU - Zaccagna, Fulvio
AU - Grist, James T.
AU - Scarcia, Luca
AU - Yeo, Leonard L.L.
AU - Tan, Benjamin Y.Q.
AU - Regenhardt, Robert W.
AU - Rouchaud, Aymeric
AU - Fiehler, Jens
AU - Sheth, Sunil
AU - Puri, Ajit S.
AU - Dyzmann, Christian
AU - Renieri, Leonardo
AU - Colasurdo, Marco
AU - Filipe, João Pedro
AU - Harker, Pablo
AU - Radu, Răzvan Alexandru
AU - Abdalkader, Mohamad
AU - Klein, Piers
AU - Ota, Takahiro
AU - Mowla, Ashkan
AU - Naamani, Kareem El
AU - Jabbour, Pascal
AU - Biswas, Arundhati
AU - Clarençon, Frédéric
AU - Siegler, James E.
N1 - Publisher Copyright:
© 2026 by American Journal of Neuroradiology.
PY - 2026/8/1
Y1 - 2026/8/1
N2 - BACKGROUND AND PURPOSE: The role of endovascular thrombectomy for acute ischemic stroke due to M2 MCA occlusion remains uncertain, in part because angiographic recanalization rates are lower than those achieved in large-vessel occlusion. The hy poperfusion intensity ratio (HIR), a perfusion-derived marker of collateral physiology, has been associated with infarct evolution and outcomes, but its relationship with the technical success of thrombectomy in M2 occlusion is unknown. MATERIALS AND METHODS: In this retrospective, multinational study of the Multicenter Analysis of Primary Distal Medium Vessel Occlusions: Effect of Mechanical Thrombectomy (MAD-MT) Consortium registry, patients with M2 MCA occlusion who underwent EVT between September 2017 and July 2023 were included. Multivariable logistic regression analysis for successful EVT (mTICI 2b-3) was performed with HIR alongside demographic and stroke characteristics. RESULTS: Among 111 patients with M2 MCA occlusion, 23 (21%) had unsuccessful EVT and 88 (79%) had successful EVT. HIR (0.50 [0.00–0.63] versus 0.20 [0.00–0.40], P ¼ .007) and NIHSS score (15 [10–18] versus 10 [7–16], P ¼ .05) were significantly lower in patients with mTICI 2b-3, along with a significantly higher ASPECTS (8 [6–10] versus 9 [8–10], P ¼ .03). In the multivariable logistic regression analysis, higher HIR, representing impaired collateral circulation, was independently associated with lower odds of mTICI 2b-3 (OR per 0.1-unit increase, 0.80; 95% CI, 0.64–0.98; P ¼ .038). CONCLUSIONS: This retrospective study suggests that HIR may serve as a predictor of success in EVT and a potentially useful adjunct tool for decision-making in patients who have had MeVO stroke. However, the limited sample size and unmeasured con founders should be considered. These findings underscore the role that perfusion imaging–based quantitative collateral assessments can play in prognosis for these patients.
AB - BACKGROUND AND PURPOSE: The role of endovascular thrombectomy for acute ischemic stroke due to M2 MCA occlusion remains uncertain, in part because angiographic recanalization rates are lower than those achieved in large-vessel occlusion. The hy poperfusion intensity ratio (HIR), a perfusion-derived marker of collateral physiology, has been associated with infarct evolution and outcomes, but its relationship with the technical success of thrombectomy in M2 occlusion is unknown. MATERIALS AND METHODS: In this retrospective, multinational study of the Multicenter Analysis of Primary Distal Medium Vessel Occlusions: Effect of Mechanical Thrombectomy (MAD-MT) Consortium registry, patients with M2 MCA occlusion who underwent EVT between September 2017 and July 2023 were included. Multivariable logistic regression analysis for successful EVT (mTICI 2b-3) was performed with HIR alongside demographic and stroke characteristics. RESULTS: Among 111 patients with M2 MCA occlusion, 23 (21%) had unsuccessful EVT and 88 (79%) had successful EVT. HIR (0.50 [0.00–0.63] versus 0.20 [0.00–0.40], P ¼ .007) and NIHSS score (15 [10–18] versus 10 [7–16], P ¼ .05) were significantly lower in patients with mTICI 2b-3, along with a significantly higher ASPECTS (8 [6–10] versus 9 [8–10], P ¼ .03). In the multivariable logistic regression analysis, higher HIR, representing impaired collateral circulation, was independently associated with lower odds of mTICI 2b-3 (OR per 0.1-unit increase, 0.80; 95% CI, 0.64–0.98; P ¼ .038). CONCLUSIONS: This retrospective study suggests that HIR may serve as a predictor of success in EVT and a potentially useful adjunct tool for decision-making in patients who have had MeVO stroke. However, the limited sample size and unmeasured con founders should be considered. These findings underscore the role that perfusion imaging–based quantitative collateral assessments can play in prognosis for these patients.
UR - https://www.scopus.com/pages/publications/105046526235
UR - https://www.scopus.com/pages/publications/105046526235#tab=citedBy
U2 - 10.3174/ajnr.A9236
DO - 10.3174/ajnr.A9236
M3 - Article
C2 - 41698817
AN - SCOPUS:105046526235
SN - 0195-6108
VL - 47
SP - 2046
EP - 2054
JO - American Journal of Neuroradiology
JF - American Journal of Neuroradiology
IS - 8
ER -