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

Authors

Norma J Diel, Davide Strambo, Mohamad Abdalkader, Muhammad M Qureshi, Vincent Dunet, Bruno Bartolini, Silvia Pistocchi, Daniel Strbian, Silja Räty, Christian Herweh, Markus Möhlenbruch, Marta Olivé-Gadea, Marc Ribo, Marios Psychogios, Urs Fischer, Anh Nguyen, Joji B Kuramatsu, David Haupenthal, Martin Köhrmann, Cornelius Deuschl, Jordi Kühne Escolà, Jelle Demeestere, Robin Lemmens, Lieselotte Vandewalle, Shadi Yaghi, Liqi Shu, Vivek Yedavalli, S Farzad Maroufi, Volker Puetz, Daniel P O Kaiser, Johannes Kaesmacher, Adnan Mujanovic, Dominique Cornelius Marterstock, Tobias Engelhorn, Manuel Requena, Piers Klein, Brandon Doan, Teresa Jordà-Baleri, Diogo C Haussen, Mahmoud H Mohammaden, Hend Abdelhamid, Lorena Souza Viana, Bruno Cunha, Isabel Fragata, Michele Romoli, Maria Ruggiero, Francesco Diana, Wei Hu, Chao Zhang, Pekka Virtanen, Riikka Lauha, Stavros Matsoukas, Johanna T Fifi, Sunil A Sheth, Sergio A Salazar-Marioni, João Pedro Marto, João Nuno Ramos, Milena Miszczuk, Christoph Riegler, Sven Poli, Khouloud Poli, Luca Scarcia, Ashutosh P Jadhav, Volker Maus, Alexandra Aust, Furkan Yapici, Adnan H Siddiqui, Andre Monteiro, Hesham E Masoud, Momotaz Begum, Maxim Mokin, Shail Thanki, Kemal Alpay, Pauli Ylikotila, James Ernest Siegler, Italo Linfante, Guilherme Dabus, Negar Asdaghi, Vasu Saini, Christian H Nolte, Eberhard Siebert, Bettina L Serrallach, Charlotte S Weyland, Lukas Meyer, Anne Berberich, Peter Arthur Ringleb, Raul G Nogueira, Patrik Michel, Simon Nagel, Thanh N Nguyen

Published in

Stroke. Jul 09, 2026. Epub Jul 09, 2026.

Abstract

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.
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. 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).
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]; P_interaction=0.009) and higher mortality (ratio of OR, 1.82 [95% CI, 1.10-3.03]; P_interaction=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]; P_interaction=0.044).
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.
URL: https://osf.io/62mwt; Unique identifier: XXXX.

PMID:
42422957
Bibliographic data and abstract were imported from PubMed on 09 Jul 2026.

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