Salim Hamza Adel, Lakhani Dhairya A, Me Janet, Balar Aneri, Huang Shenwen, Hoseinyazdi Meisam, Luna Licia, Deng Francis, Hyson Nathan Z, Bahouth Mona, Dmytriw Adam A, Guenego Adrien, Albers Gregory W, Lu Hanzhang, Urrutia Victor C, Nael Kambiz, Marsh Elisabeth B, Hillis Argye E, Llinas Rafael, Wintermark Max, Heit Jeremy J, Faizy Tobias D, Yedavalli Vivek
Department of Neuroradiology, MD Anderson Medical Center, Houston, TX, USA.
Division of Neuroradiology, Department of Radiology, Johns Hopkins Medical Center, Baltimore, MD, USA.
Interv Neuroradiol. 2025 Jun 17:15910199251342839. doi: 10.1177/15910199251342839.
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, = 0.036) and Tmax > 6 s volume (rho = 0.45, 95% CI, 0.09-0.71, = 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.
背景
孤立性大脑后动脉（PCA）闭塞占缺血性卒中的5%，由于对丘脑和视觉皮层的影响，会显著影响患者的生活质量。目前关于PCA卒中急性治疗的指南以及灌注成像的预后效用仍然有限且未得到充分探索。
方法
我们对2017年1月至2023年3月期间在两家综合医疗机构的21例孤立性PCA闭塞患者进行了回顾性分析。提取了灌注成像参数，包括最大时间（Tmax）>4秒、Tmax>6秒、Tmax>8秒、Tmax>10秒以及错配体积。主要结局是90天时的改良Rankin量表（mRS）评分。
结果
患者的中位年龄为70岁，男性占62%。最大时间>4秒的体积（rho = 0.46，95%CI，0.1 - 0.71，P = 0.036）和Tmax>6秒的体积（rho = 0.45，95%CI，0.09 - 0.71，P = 0.04）与90天mRS评分呈显著正相关。其他灌注参数，如Tmax>8秒的体积和错配体积，接近统计学意义，而rCBF和低灌注强度比未显示出显著相关性。
结论
灌注成像参数，特别是Tmax组织体积，与孤立性PCA闭塞患者的长期临床结局相关。这些发现支持了灌注成像在PCA卒中患者预后评估和管理中的潜在作用。有必要进行更大样本量的未来研究以证实这些结果，并为PCA闭塞建立标准化的灌注成像方案。
