Role of Perfusion Parameters on Outcomes and Safety of Endovascular Therapy in Posterior Cerebral Artery Stroke

Diel NJ, Strambo D, Abdalkader M, Qureshi MM, Dunet V, Bartolini B, Pistocchi S, Strbian D, Räty S, Herweh C, Möhlenbruch M, Olivé-Gadea M, Ribo M, Psychogios M, Fischer U, Nguyen A, Kuramatsu J, Haupenthal D, Köhrmann M, Deuschl C, Kühne Escolà J, Demeestere J, Lemmens R, Vandewalle L, Yaghi S, Shu L, Yedavalli V, Maroufi SF, Puetz V, Kaiser DP, Kaesmacher J, Mujanovic A, Marterstock D, Engelhorn T, Requena M, Klein P, Doan B, Jordà-Baleri T, Haussen DC, Mohammaden MH, Abdelhamid H, Souza Viana L, Cunha B, Fragata I, Romoli M, Ruggiero M, Diana F, Hu W, Zhang C, Virtanen P, Lauha R, Matsoukas S, Fifi JT, Sheth SA, Salazar-Marioni SA, Marto JP, Ramos JN, Miszczuk M, Riegler C, Poli S, Poli K, Scarcia L, Jadhav AP, Maus V, Aust A, Yapici F, Siddiqui AH, Monteiro A, Jaikumar V, Masoud HE, Begum M, Mokin M, Thanki S, Alpay K, Ylikotila P, Siegler JE, Linfante I, Dabus G, Asdaghi N, Saini V, Nolte CH, Siebert E, Serrallach BL, Weyland CS, Meyer L, Berberich A, Ringleb PA, Nogueira RG, Michel P, Nagel S, Nguyen TN (2026)

Publication Type: Journal article

Publication year: 2026

Journal

Book Volume: 57

Journal Issue: 9

DOI: 10.1161/STROKEAHA.126.055949

Abstract

BACKGROUND: – The optimal management of isolated posterior cerebral artery occlusion (iPCAO) remains unclear. We investigated whether baseline perfusion imaging parameters are associated with clinical outcomes and whether they modify the association between endovascular therapy (EVT) and outcomes in iPCAO. METHODS: – This prespecified secondary analysis of the international, multicenter, observational PLATO (Posterior Cerebral Artery Occlusion) registry (35 centers, 10 countries, 2015–2025) included consecutive adults with unilateral iPCAO and baseline perfusion imaging (computed tomography or magnetic resonance imaging) with reconstructed parameters. The primary end point was an excellent 90-day outcome (modified Rankin Scale score, 0–1). Perfusion parameters included hypoperfusion volume, infarct core volume, and mismatch ratio. The primary analysis used multivariable mixed-effects regression models (center as random effect) to assess associations between perfusion parameters and outcomes, adjusting for age, sex, treatment year, prestroke modified Rankin Scale score, baseline National Institutes of Health Stroke Scale score, diabetes, stroke cause, posterior circulation Acute Stroke Prognosis Early Computed Tomography Score, occlusion site, intravenous thrombolysis, and onset-to-door time. To test whether the association between EVT and outcomes varies according to baseline perfusion parameters, we evaluated treatment-by-perfusion interactions by including interaction terms (treatment×perfusion parameter) in inverse probability of treatment weighting–adjusted models, with results expressed as ratios of odds ratios (ORs). RESULTS: – Of 1811 patients with iPCAO, 443 met inclusion criteria (median age, 74 years; 41.8% female). Larger hypoperfusion volume was associated with lower odds of excellent outcome (adjusted OR, 0.72 [95% CI, 0.58–0.89] per 1-unit increase in natural logarithm–transformed volume). No interaction between perfusion parameters and EVT was observed for the primary outcome. However, increasing core volume was associated with a progressively less favorable modified Rankin Scale score shift (ratio of OR, 0.66 [95% CI, 0.48–0.90]; Pinteraction=0.009) and higher mortality (ratio of OR, 1.82 [95% CI, 1.10–3.03]; Pinteraction=0.021) with EVT compared with medical management. Increasing hypoperfusion volume was associated with a higher risk of symptomatic intracranial hemorrhage with EVT (ratio of OR, 10.15 [95% CI, 1.06–96.93]; Pinteraction=0.044). CONCLUSIONS: – In iPCAO, perfusion imaging provides independent prognostic information but does not identify patients with potential benefit from EVT and may instead indicate those at higher procedural risk. REGISTRATION: – URL: https://osf.io/62mwt; Unique identifier: NCT05291637.

Authors with CRIS profile

Involved external institutions

University of Science and Technology of China (USTC) China (CN) Helsinki University Central Hospital (HUCH) / Helsingin seudun yliopistollinen keskussairaala (HYKS) Finland (FI) Icahn School of Medicine at Mount Sinai United States (USA) (US) University of Texas Health Science Center at Houston (UTHealth Houston) United States (USA) (US) New University of Lisbon / Universidade Nova de Lisboa Portugal (PT) Hospital de Egas Moniz Portugal (PT) Berliner Institut für Gesundheitsforschung in der Charité / Berlin Institute of Health at Charité (BIH) Germany (DE) Eberhard Karls Universität Tübingen Germany (DE) Centre hospitalier universitaire Henri-Mondor (CHU Henri-Mondor) France (FR) Barrow Neurological Institute United States (USA) (US) Klinikum Aschaffenburg-Alzenau Germany (DE) Klinikum Dortmund Germany (DE) University at Buffalo. State University of New York (SUNY Buffalo) United States (USA) (US) State University of New York Upstate Medical University (SUNY) United States (USA) (US) University of South Florida (USF) United States (USA) (US) Turku University Hospital / Turun yliopistollinen keskussairaala (TYKS) Finland (FI) University of Chicago United States (USA) (US) Baptist Health South Florida United States (USA) (US) University of Miami United States (USA) (US) Inselspital, Universitätsspital Bern Switzerland (CH) Universitätsklinikum Aachen (UKA) Germany (DE) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) Klinikum der Stadt Ludwigshafen am Rhein gGmbH Germany (DE) Universitätsklinikum Heidelberg Germany (DE) University of Pittsburgh Medical Center (UPMC) United States (USA) (US) Lausanne University Hospital / Centre hospitalier universitaire vaudois (CHUV) Switzerland (CH) Boston Medical Center (BMC) United States (USA) (US) Universitätsklinikum Carl Gustav Carus Dresden Germany (DE) Universitätsspital Basel Switzerland (CH) Universitätsklinikum Essen Germany (DE) University Hospital Leuven (UZ) / Universitaire ziekenhuizen Leuven Belgium (BE) Jersey Shore University Medical Center (JSUMC) United States (USA) (US) Johns Hopkins Hospital United States (USA) (US) Ochsner Health System United States (USA) (US) Grady Memorial Hospital United States (USA) (US) Central Lisbon University Hospital Centre / Centro Hospitalar Universitário de Lisboa Central (CHULC) Portugal (PT) Ospedale “M. Bufalini” di Cesena Italy (IT) Hospital de la Santa Creu i Sant Pau Spain (ES)

How to cite

APA:

Diel, N.J., Strambo, D., Abdalkader, M., Qureshi, M.M., Dunet, V., Bartolini, B.,... Nguyen, T.N. (2026). Role of Perfusion Parameters on Outcomes and Safety of Endovascular Therapy in Posterior Cerebral Artery Stroke. Stroke, 57(9). https://doi.org/10.1161/STROKEAHA.126.055949

MLA:

Diel, Norma J., et al. "Role of Perfusion Parameters on Outcomes and Safety of Endovascular Therapy in Posterior Cerebral Artery Stroke." Stroke 57.9 (2026).

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