Tmax Volumes Predict Final Infarct Size and Functional Outcome in Ischemic Stroke Patients Receiving Endovascular Treatment

Objective The objective of this paper was to explore the utility of time to maximum concentration (T-max)-based target mismatch on computed tomography perfusion (CTP) in predicting radiological and clinical outcomes in patients with acute ischemic stroke (AIS) with anterior circulation large vessel occlusion (LVO) selected for endovascular treatment (EVT). Methods Patients with AIS underwent CTP within 24 hours from onset followed by EVT. Critically hypoperfused tissue and ischemic core volumes were automatically calculated using T-max thresholds >9.5 seconds and >16 seconds, respectively. The difference between T-max > 9.5 seconds and T-max > 16 seconds volumes and the ratio between T-max > 9.5 seconds and T-max > 16 seconds volumes were considered ischemic penumbra and T-max mismatch ratio, respectively. Final infarct volume (FIV) was measured on follow-up non-contrast computed tomography (CT) at 24 hours. Favorable clinical outcome was defined as 90-day modified Rankin Scale 0 to 2. Predictors of FIV and outcome were assessed with multivariable logistic regression. Optimal T-max volumes for identification of good outcome was defined using receiver operating curves. Results A total of 393 patients were included, of whom 298 (75.8%) achieved successful recanalization and 258 (65.5%) achieved good outcome. In multivariable analyses, all T-max parameters were independent predictors of FIV and outcome. T-max > 16 seconds volume had the strongest association with FIV (beta coefficient = 0.596 p <0.001) and good outcome (odds ratio [OR] = 0.96 per 1 ml increase, 95% confidence interval [CI] = 0.95-0.97, p < 0.001). T-max > 16 seconds volume had the highest discriminative ability for good outcome (area under the curve [AUC] = 0.88, 95% CI = 0.842-0.909). A T-max > 16 seconds volume of <= 67 ml best identified subjects with favorable outcome (sensitivity = 0.91 and specificity = 0.73). Interpretation T-max target mismatch predicts radiological and clinical outcomes in patients with AIS with LVO receiving EVT within 24 hours from onset. ANN NEUROL 2022