Abstract TP140: Effect of MR-Guided Perfusion Imaging Mismatch Profiles Within 6 Hours on Endovascular Thrombectomy Outcomes

Abstract

Background: The treatment of acute ischemic stroke (AIS) aims to achieve early vascular recanalization and reperfusion of the penumbra. However, the effect of early penumbral imaging within 6 hours on clinical outcomes remains unclear. Objective: The objective of this study was to determine the effect of magnetic resonance-guided (MR-guided) perfusion imaging within 6 hours after symptom onset on endovascular thrombectomy outcomes in AIS patients. Methods: We prospectively collected the clinical information of consecutive AIS patients undergoing endovascular thrombectomy based on MR-guided perfusion imaging within 6 hours after symptom onset from AISRNA and EVTRNA studies. The primary outcome was defined as the poor outcome (mRS > 2 within 90 days). The perfusion-weighted imaging/diffusion-weighted imaging (PWI/DWI) mismatch was assessed by an automated software. Results: We enrolled 84 patients (25 in the mismatch ≤ 1.8 group and 59 in the mismatch > 1.8 group). Significant difference was found between the mismatch>1.8 group and the mismatch≤1.8 group for the incidence of disabling stroke (mRS > 2) within 90 days (40.7% vs. 68.0%, OR: 3.099, 95% CI: 1.154-8.323, P =0.025). Intracranial hemorrhage occurred in 8 patients (13.6%) in the mismatch > 1.8 group and 10 patients in the mismatch ≤ 1.8 group (40.0%) (P = 0.010). The risk of severe cerebral edema was 2/59 (3.4%) vs. 7/25 (28.0%) (P = 0.004). These findings remained stable after adjustment. Conclusion: MR-guided perfusion imaging mismatch profiles within 6 hours after symptom onset may be feasible to improve clinical outcomes and reduce clinically ineffective reperfusion after endovascular thrombectomy.