Post-endovascular thrombectomy perfusion imaging (CT and MR) as a prognostic biomarker and patient-selection tool for adjuvant therapy: A systematic review, meta-analysis, and clinical threshold framework.
Roni Eichel, Michael Teitcher, Stefan Mausbach et al.
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In 30 seconds
This systematic review and meta-analysis evaluated post-endovascular thrombectomy (EVT) perfusion imaging as a prognostic biomarker for functional independence in patients with large vessel occlusion stroke. Analyzing data from eight studies involving 670 patients, the research found that residual hypoperfusion was present in 21-53% of successful reperfusions, significantly correlating with reduced odds of achieving functional independence (pooled OR 0.28).
Key findings
- Residual hypoperfusion was found in 21-53% of successful reperfusions.
- Pooled odds of functional independence were significantly lower with residual hypoperfusion (OR 0.28).
- A Tmax >6 s volume <3.5 mL at 30-90 min post-EVT was the validated CT-perfusion threshold.
- For MR perfusion, an rCBV-defined impaired-microvascular-reperfusion volume >5 mL was identified as a threshold.
Why it matters
Understanding the role of post-EVT perfusion imaging can help clinicians identify patients at risk of poor functional outcomes, guiding decisions for adjuvant therapies and improving patient selection for future interventions.