Association between Cerebral Blood Volume Index and Excellent Reperfusion in Acute Ischemic Stroke Patients Undergoing Mechanical Thrombectomy.

INTRODUCTION

Excellent reperfusion following mechanical thrombectomy (MT) is strongly associated with favorable clinical outcomes in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO). This study aims to investigate the association between the cerebral blood volume (CBV) index-a surrogate marker of collateral status-and the likelihood of achieving excellent reperfusion after MT in AIS-LVO patients.

METHODS

A retrospective analysis was conducted on a consecutive series of anterior circulation AIS-LVO patients undergoing MT. CBV index was calculated using RAPID software as the ratio of mean CBV in the penumbral region (Tmax > 6 seconds) to that in the unaffected brain region (Tmax≤4 seconds). The primary outcome was excellent reperfusion, defined as an expanded Thrombolysis in Cerebral Infarction (eTICI) score of 2c/3.

RESULTS

Of the 245 patients (54.70% male, median age 71 years), 152 (62.04%) achieved excellent reperfusion. ROC analysis identified a CBV index ≥0.6 as the optimal cutoff for predicting excellent reperfusion (AUC=0.743). Multivariable logistic regression showed a positive association between the CBV index and excellent reperfusion (adjusted OR = 1.221 per 0.1-point increase, 95% CI: 1.028-1.449, p=0.023). Patients with a favorable CBV index (≥0.6) were significantly more likely to achieve excellent reperfusion (adjusted OR = 2.785, 95% CI: 1.258-6.164, p = 0.012).

DISCUSSION

These findings suggest that the CBV index is an independent predictor of excellent reperfusion after MT in AIS-LVO patients. This association may reflect the importance of tissue- level collateral perfusion in achieving successful reperfusion. Limitations include the singlecenter, retrospective design and the potential for selection bias.

CONCLUSION

The CBV index is positively associated with excellent reperfusion in AIS-LVO patients undergoing MT. Further prospective studies are warranted to validate these findings and explore the underlying mechanisms.