Abstract TP63: Hypoperfusion Volume Immediately After Endovascular Reperfusion Therapies: A Highly Accurate Early Predictor of Clinical Outcome After Recanalization

Abstract

Despite successful recanalization after endovascular treatment (EVT), a proportion of patients will not experience favorable outcome. We hypothesize that an early computed tomography perfusion (CTP-AFT) immediately after EVT may improve clinical outcome prediction. Methods: Consecutive patients with large vessel occlusion (LVO) who achieved partial (TICI 2a) or complete (TICI 2b/3) recanalization after EVT underwent CTP-AFT within 30 minutes. Different CTP parameters were measured with the Rapid software. Clinical data were recorded including dramatic recovery (DR: ≥8 points decrease from baseline NIHSS or NIHSS 0-2 at 24 hours) Results: Forty-six LVO were included, median baseline NIHSS was 18 (P25-75 13-22). Final recanalization grades were: TICI 2a, 5 patients (10.8%); TICI 2b, 19 (41.6%); and TICI 3, 22 (47.8%). Median 24h infarct volume was 7.5 cc (0-19). Median NIHSS decrease after 24h was 8 (1-16). Twenty-seven (58%) patients experienced DR. The volume with Tmax>6 seconds was the only CTP parameter that correlated with degree of recanalization: TICI 2a: 102cc (60-138); TICI 2b: 15cc (0-37); and TICI 3: 0cc (0-5), p<0.005. Lower Tmax>6s volume was associated with lower 24h-infarct volume (p<0.01), lower 24h NIHSS (p<0.01) and higher probability of DR (p<0.01). A ROC curve identified a Tmax>6s volume <5.5cc as the best cut-off point to predict DR (sens 73.7%, specif 70.4%, AUC 0.74). A logistic regression analysis adjusted by age, baseline NIHSS, ASPECTS, occlusion location and time and degree of recanalization showed that the only predictor of DR was a Tmax>6s volume <5.5cc (OR 21.6, CI 2.7-173.2, p<0.01). Conclusion: CTP maps performed immediately after EVT correlated with degree of recanalization. However, a low Tmax>6s volume predicted clinical outcome better than post-procedural TICI scores.