Hypoperfusion Intensity Ratio Predicts Successful Recanalization in M2 MCA Occlusion Stroke Treated with Thrombectomy
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND AND PURPOSE: The role of endovascular thrombectomy for acute ischemic stroke due to M2 middle cerebral artery occlusion remains uncertain, in part because angiographic recanalization rates are lower than those achieved in large-vessel occlusion. The hypoperfusion intensity ratio (HIR), a perfusion-derived marker of collateral physiology, has been associated with infarct evolution and outcomes, but its relationship with technical success of thrombectomy in M2 occlusion is unknown. MATERIALS AND METHODS: In this retrospective, multinational study of the 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 M2 MCA occlusion patients, 23 (21%) had unsuccessful EVT and 88 (79%) had successful EVT. HIR (0.50 (0.00-0.63) vs 0.20 (0.00-0.40), p = 0.007) and NIHSS score (15 (10-18) vs 10 (7-16), p = 0.05) were significantly lower in mTICI 2b-3 patients, along with a significantly higher ASPECTS (8 (6-10) vs 9 (8-10), p = 0.03). In the multivariable logistic regression analysis, higher HIR, representing impaired collateral circulation, was independently associated with lower odds of mTICI 2b-3 (OR 0.03, 95% CI: 0.00-0.41, p = 0.009). 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 MeVO stroke patients. However, the limited sample size and unmeasured cofounders should be considered. These findings underscore the role that perfusion imaging-based quantitative collateral assessments can play in prognosis for these patients.
DOI: 10.3174/ajnr.a9236
Institutions: West Virginia University, Johns Hopkins University, Johns Hopkins Medicine, Johns Hopkins Hospital, Toronto Metropolitan University, Birjand University of Medical Sciences, University of Münster, University Hospital Münster, Stanford Medicine, University of California, Los Angeles, Brown University, University of Cincinnati, Erasmus Hospital, Brigham and Women's Hospital, Harvard University, Massachusetts General Hospital
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7129049230