Jazayeri Seyed Behnam, Zamarud Aroosa, Derhab Mohamed, Ghozy Sherief, Mirbeyk Mona, Heit Jeremy J, Kallmes David F
Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
Department of Radiology, Stanford University School of Medicine, Stanford, California, USA.
J Neurointerv Surg. 2025 Feb 13. doi: 10.1136/jnis-2024-023000.
The hypoperfusion intensity ratio (HIR) has emerged as a vital measure of tissue-level collateral blood flow, helping to identify patients who are likely to benefit from mechanical thrombectomy (MT). We aimed to assess the HIR's predictive accuracy for clinical outcomes following MT in patients with acute ischemic stroke.
PubMed, Embase, and Scopus were searched to identify studies comparing good versus poor HIR groups based on studies' reported cut-offs. We pooled binary outcomes to calculate odds ratios (OR) and continuous outcomes to calculate mean differences (MD) with 95% confidence intervals (95% CI) using random-effects models. PROSPERO registration code: CRD42024609185.
14 studies with 2987 patients, 1553 with good HIR and 1434 with poor HIR, were included in this meta-analysis. Patients with poor HIR exhibited a significantly higher baseline infarct volume compared with those with good HIR (MD 30.6 mL, 95% CI 20.8 mL to 40.3 mL, P<0.01), though baseline National Institutes of Health Stroke Scale (NIHSS) (P=0.12) and Alberta Stroke Program Early CT Score (ASPECTS) (P=0.35) were comparable between groups. The rates of infarct growth (MD 22.4 mL, 95% CI 6.7 mL to 38.0 mL, P<0.01) and 3-month mortality (OR 2.18, 95% CI 1.04 to 4.58, P=0.04) were higher among the poor HIR group and good functional recovery (modified Rankin Scale 0-2 at 3 months) was lower (OR 0.58, 95% CI 0.42 to 0.80, P<0.01). The rates of symptomatic intracranial hemorrhage (P=0.37) and successful reperfusion (P=0.47) were comparable among groups.
This meta-analysis highlights the significant negative impact of poor HIR on patient outcomes. These findings emphasize the need for personalized treatment strategies for patients with poor HIR.
低灌注强度比（HIR）已成为衡量组织水平侧支血流的重要指标，有助于识别可能从机械取栓术（MT）中获益的患者。我们旨在评估HIR对急性缺血性脑卒中患者MT后临床结局的预测准确性。
检索PubMed、Embase和Scopus数据库，以确定基于研究报告的临界值比较HIR良好组与不良组的研究。我们汇总二元结局以计算比值比（OR），汇总连续结局以计算平均差（MD），并使用随机效应模型计算95%置信区间（95%CI）。PROSPERO注册号：CRD42024609185。
本荟萃分析纳入了14项研究，共2987例患者，其中1553例HIR良好，1434例HIR不良。与HIR良好的患者相比，HIR不良的患者基线梗死体积显著更高（MD 30.6 mL，95%CI 20.8 mL至40.3 mL，P<0.01），尽管两组间基线美国国立卫生研究院卒中量表（NIHSS）评分（P=0.12）和阿尔伯塔卒中项目早期CT评分（ASPECTS）（P=0.35）相当。HIR不良组的梗死灶增长发生率（MD 22.4 mL，95%CI 6.7 mL至38.0 mL，P<0.01）和3个月死亡率（OR 2.18，95%CI 1.04至4.58，P=0.04）更高，而良好功能恢复（3个月时改良Rankin量表评分为0-2分）的比例更低（OR 0.58，95%CI 0.42至0.80，P<0.01）。两组间有症状性颅内出血发生率（P=0.37）和成功再灌注率（P=0.47）相当。
本荟萃分析突出了HIR不良对患者结局的显著负面影响。这些发现强调了对HIR不良患者采取个性化治疗策略的必要性。
