Cerebral perfusion imaging predicts final infarct volume after basilar artery thrombectomy

Nicole Yuen, Michael Mlynash, Andrea O'Riordan, Maarten Lansberg, Soren Christensen, Carlo W. Cereda, Giovanni Bianco, Dan Victor Giurgiutiu, Fana Alemseged, Marco Pileggi, Bruce Campbell, Gregory W. Albers, Jeremy J. Heit

Research output: Contribution to journalArticlepeer-review


Objectives: Cerebral perfusion imaging may be used to identify the ischemic core in acute ischemic stroke (AIS) patients with a large vessel occlusion of the anterior circulation; however, perfusion parameters that predict the ischemic core in AIS patients with a basilar artery occlusion (BAO) are poorly described. We determined which cerebral perfusion parameters best predict the ischemic core after successful endovascular thrombectomy (EVT) in BAO patients. Materials and methods: We performed multicenter retrospective study of BAO patients with perfusion imaging before EVT and a DWI after successful EVT. The ischemic core was defined as regions on CTP, which were co-registered to the final DWI infarct. Various time-to-maximum (Tmax) and cerebral blood flow (CBF) thresholds were compared to final infarct volume to determine the best predictor of the final infarct. Results: 28 patients were included in the analysis for this study. Tmax >8s (r2: 0.56; median absolute error, 16.0 mL) and Tmax >10s (r2: 0.73; median absolute error, 11.3 mL) showed the strongest agreement between the pre-EVT CTP study and the final DWI. CBF <38% (r2: 0.76; median absolute error, 8.2 mL) and CBF <34% (r2: 0.76; median absolute error, 9.1 mL) also correlated well with final infarct volume on DWI. Conclusions: Pre-EVT CT perfusion imaging is useful to predict the final ischemic infarct volume in BAO patients. Tmax >8s and Tmax >10s were the strongest predictors of the post-EVT final infarct volume.

Original languageEnglish (US)
Article number106866
JournalJournal of Stroke and Cerebrovascular Diseases
Issue number1
StatePublished - Jan 2023


  • Imaging
  • Infarct
  • Perfusion
  • Stroke
  • Thrombectomy

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine


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