anterior_circulation_large_vessel_occlusion

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anterior_circulation_large_vessel_occlusion [2025/07/10 20:43] – administradoranterior_circulation_large_vessel_occlusion [2025/07/10 20:47] (current) – administrador
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 ===== Prognosis ===== ===== Prognosis =====
  
-In a [[retrospective cohort study]] +[[Anterior Circulation Large Vessel Occlusion Prognosis]]
-Asimos et al. +
-from Atrium Health, Charlotte (Emergency Medicine, Neurosciences Institute, Quality Analytics, Radiology, Neurosurgery, Neurology) +
-published in the [[Interventional Neuroradiology Journal]] +
-to assess whether [[hypoperfusion]] intensity ratio (HIR) and [[cerebral blood volume index]] (CBVI) measured via [[CT perfusion]] at referring non-thrombectomy centers predict favorable 90‑day outcomes post-transfer for [[thrombectomy]] in [[anterior circulation]] [[large vessel occlusion]] (ACLVO). +
-CBVI—as a continuous measure and specifically > 0.7—correlated with functional independence ([[mRS]] ≤ 2) at 90 days both overall and in recanalized patients. In contrast, HIR thresholds and combined collateral scores were not predictive +
-((Asimos AW, Yang H, Strong D, Teli KJ, Clemente JD, DeFilipp G, Bernard J, Stetler W, Parish JM, Hines A, Rhoten JB, Karamchandani RR. Association of [[hypoperfusion intensity ratio]] and [[cerebral blood volume Index]] with good [[outcome]] in patients transferred for [[thrombectomy]]. Interv Neuroradiol. 2025 Jul 10:15910199251352046. doi: 10.1177/15910199251352046. Epub ahead of print. PMID: 40638076.)). +
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-==== Critical Review ==== +
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-Strengths +
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-Excellent [[sample size]] (n = 497), with high treatment prevalence (93% thrombectomy) supporting real-world relevance. +
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-Rigorous adjustment for confounders in multivariable models enhances validity. +
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-Weaknesses +
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-Retrospective and single-center design at a large referral system may limit external [[generalizability]]. +
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-No direct comparisons to other perfusion metrics like Tmax or ischemic core volumes—makes it difficult to situate CBVI within broader CTP prognostication tools. +
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-HIR binary thresholds (0.4–0.6) may lack granularity; their univariate non-association could stem from arbitrary cutoffs rather than biological irrelevance. +
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-Unclear reproducibility or inter-observer reliability of CBVI quantification across centers or software versions. +
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-Statistical note +
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-Adjusted OR of 1.73 for CBVI > 0.7 is clinically meaningful, but [[confidence interval]] (1.13–2.65) suggests moderate precision. +
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-==== Final Verdict ==== +
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-Rating: 6.5 / 10 +
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-Takeaway for practitioners: CBVI from CT perfusion at referring centers could offer a pragmatic predictor of functional independence after thrombectomy, especially when > 0.7. However, its standalone prognostic value remains uncertain until validated prospectively and benchmarked against established perfusion metrics. +
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-Bottom line: CBVI appears promising as a simple, transportable predictor of favorable outcome in ACLVO, but further multi‑center, prospective validation and comparison studies are needed before adoption into routine transfer decision-making. +
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-Categories: Retrospective Studies, Stroke Imaging, Thrombectomy Outcomes +
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-Tags: CT perfusion, CBVI, HIR, collateral perfusion, stroke prognostication, thrombectomy, anterior circulation LVO+
  
  
  • anterior_circulation_large_vessel_occlusion.txt
  • Last modified: 2025/07/10 20:47
  • by administrador