Abstract
Background and Purpose
Ischemic strokes due to isolated posterior cerebral artery (PCA) occlusions represent 5% of all strokes but have significant impacts on patients’ quality of life, primarily due to visual deficits and thalamic involvement. Current guidelines for acute PCA occlusion management are sparse, and the prognostic value of perfusion imaging parameters remains underexplored.
Methods
We conducted a retrospective analysis of 32 patients with isolated PCA occlusions treated at Johns Hopkins Medical Institutions between January 2017 and March 2023. Patients underwent pretreatment perfusion imaging, with perfusion parameters analyzed using RAPID software. The primary outcome was short-term clinical outcome as measured by the National Institutes of Health Stroke Scale (NIHSS) at discharge.
Results
The median age of the cohort was 70 years, with 34% female and 66% male. Significant correlations were found between NIHSS at discharge and various perfusion parameters, including time-to-maximum (Tmax) >6 seconds (ρ = .55, p = .004), Tmax >8 seconds (ρ = .59, p = .002), Tmax >10 seconds (ρ = .6, p = .001), mismatch volume (ρ = .51, p = .008), and cerebral blood volume (CBV) < 34% (ρ = .59, p = .002).
Conclusions
Tmax and CBV volumes significantly correlated with discharge NIHSS with marginal superiority of Tmax >10 seconds and CBV <42% volumes. These findings suggest that CT and MR perfusion imaging can play a crucial role in the acute management of PCA strokes, though larger, standardized studies are needed to validate these results and refine imaging thresholds specific to posterior circulation infarcts.
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This post is Copyright: Hamza Adel Salim,
Shenwen Huang,
Dhairya A. Lakhani,
Janet Mei,
Aneri Balar,
Basel Musmar,
Nimer Adeeb,
Meisam Hoseinyazdi,
Licia Luna,
Francis Deng,
Nathan Z. Hyson,
Mona Bahouth,
Adam A. Dmytriw,
Adrien Guenego,
Gregory W. Albers’s,
Hanzhang Lu,
Victor C. Urrutia,
Kambiz Nael,
Elisabeth B Marsh,
Argye E. Hillis,
Raf Llinas,
Max Wintermark,
Jeremy J. Heit,
Tobias D. Faizy,
Vivek Yedavalli | September 3, 2024
Wiley: Journal of Neuroimaging: Table of Contents