{
  "abstract": "PURPOSE: CT-perfusion (CTP) may underestimate the size of the ischemic core, a phenomenon known as “perfusion scotoma”. We aimed to investigate the prevalence of perfusion scotoma, characterize its baseline predictors, and explore its association with functional outcomes in a real-world population of stroke patients treated with endovascular treatment (EVT). METHODS: Data were obtained from a prospective EVT registry, selecting patients with successful recanalization (final mTICI ≥2b), a good quality baseline CTP, and an available 24-hour non-contrast CT. Ischemic core underestimated volume (ICuV) was calculated as the difference between follow-up infarct volume and CTP-estimated ischemic core. The primary outcome was the presence of perfusion scotoma, defined as ICuV ≥10 mL. Baseline characteristics with p value <0.20 in univariable comparisons were entered in a backward stepwise, multivariable logistic regression analysis to identify factors independently associated with perfusion scotoma. RESULTS: A total of 464 patients of 672 (69%) were included in the analysis. The median age was 74 years (IQR=68-83), 215 (46.3%) were males, and 116 (25%) had a perfusion scotoma. Perfusion scotoma was independently associated with male sex (adjusted OR 1.62 [95%CI 1.01-2.51]; p=0.04), more distal site of occlusion (adjusted OR 1.60 [95%CI 1.10-2.34]; p=0.01; per each 1-point increase: terminal ICA to M1 to M2), lower ASPECTS at admission (adjusted OR 0.64 [95%CI 0.54-0.76]; p<0.001; per each 1-point increase), and longer onset-to-CT time (adjusted OR 1.05, [95%CI 1.01-1.10]; p=0.03; per each 1-hour increase). The optimal onset-to-CT time cutoff to distinguish between patients without and with perfusion scotoma was 420 minutes. Perfusion scotoma was associated with 90-day ordinal mRS (adjusted common OR [acOR] 3.16 [95%CI 2.12–4.76]). CONCLUSION: Perfusion scotoma occurred in 1 out of every 4 patients. Baseline predictors included male sex, lower ASPECTS, more distal vessel occlusion, and longer onset-to-CT time. Perfusion scotoma was associated with poorer functional outcomes.",
  "abstract_shown": true,
  "affiliations": [
    "From the Neuroradiology Unit, Department of Radiology (G.B., F.L., G.U.M., A.G., E.F.), Careggi University Hospital, Florence, Italy",
    "Department of Biomedical Sciences (U.P., S.M.), Humanitas University, Milan, Italy",
    "Department of Neurology (U.P., S.M.), IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy",
    "Department of Radiology (J.M.O.), University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada",
    "IRCCS San Camillo Hospital (I.C.), Venice, Italy",
    "Stroke Unit (A. Poggesi), Careggi University Hospital, Florence, Italy",
    "Department of Clinical and Experimental Sciences, Neurology Unit (A. Padovani, A.M.), University of Brescia, Brescia, Italy",
    "Department of Experimental and Clinical Biomedical Sciences, Neuroradiology Unit (E.F.), University of Florence, Florence, Italy"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 12,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Giorgio Busto",
      "orcid": "0000-0002-7007-6030"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Umberto Pensato"
    },
    {
      "affs": [
        3
      ],
      "name": "Johanna M. Ospel"
    },
    {
      "affs": [
        4
      ],
      "name": "Ilaria Casetta",
      "orcid": "0000-0003-4099-8875"
    },
    {
      "affs": [
        0
      ],
      "name": "Francesco Loverre",
      "orcid": "0009-0008-6688-4220"
    },
    {
      "affs": [
        0
      ],
      "name": "Giorgio U. Marcello",
      "orcid": "0009-0007-2836-3638"
    },
    {
      "affs": [
        5
      ],
      "name": "Anna Poggesi"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Simona Marcheselli"
    },
    {
      "affs": [
        0
      ],
      "name": "Andrea Ginestroni"
    },
    {
      "affs": [
        6
      ],
      "name": "Alessandro Padovani"
    },
    {
      "affs": [
        6
      ],
      "name": "Andrea Morotti",
      "orcid": "0000-0002-6558-1155"
    },
    {
      "affs": [
        0,
        7
      ],
      "name": "Enrico Fainardi"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/f79hrbptjqzf2.bib",
  "cited_by": 1,
  "doi": "10.3174/ajnr.a9321",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13738332/",
  "id": "f79hrbptjqzf2",
  "issns": [
    "0195-6108",
    "1936-959X"
  ],
  "landing_url": "https://doi.org/10.3174/ajnr.a9321",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Neurovascular/Stroke Imaging"
    ],
    [
      "heading",
      "Research"
    ],
    [
      "openalex",
      "2728|Acute Ischemic Stroke Management"
    ]
  ],
  "openalex": "W7140628653",
  "pdf_url": null,
  "pmcid": "PMC13738332",
  "pmid": "41887746",
  "published": "2026-11-06",
  "publisher": "American Society of Neuroradiology",
  "ris": "https://research.draconitic.com/paper/f79hrbptjqzf2.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T12:23:20Z",
      "native_id": "PMC13738332",
      "source": "pmc",
      "url": "https://doi.org/10.3174/ajnr.a9321"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2728|Acute Ischemic Stroke Management",
      "subfield": "neurology"
    }
  ],
  "title": "Characterization of Perfusion Scotoma in Acute Ischemic Stroke after Endovascular Treatment",
  "title_text": "Characterization of Perfusion Scotoma in Acute Ischemic Stroke after Endovascular Treatment",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T12:23:20Z",
  "url": "https://research.draconitic.com/paper/f79hrbptjqzf2",
  "venue": "AJNR: American Journal of Neuroradiology",
  "versions": []
}