Peer-reviewedCC BY-NCStroke (Hoboken, N.J.)1 Nov 2026

Association Between Hypoperfusion Intensity Ratio and Outcomes After Endovascular Thrombectomy in Posterior Circulation Stroke: A Retrospective Study

Ming Mo¹
Chun Rong Tao²
Chun Yu Yu¹
Zhong Jun Chen¹
Wei Hu²

¹Central Hospital of Dalian University of Technology, Liaoning, China (M.M., C.Y.Y., Z.J.C.).
²Department of Neurology, The First Affiliated Hospital of USTC, Luyang District, Hefei, Anhui, China (C.R.T., W.H.).

Abstract

Background

The prognostic utility of the hypoperfusion intensity ratio (HIR) in posterior circulation stroke is undefined. We investigated the association between pretreatment HIR and outcomes after mechanical thrombectomy for acute posterior circulation large vessel occlusion.Methods

This post hoc analysis of the ATTENTION (Endovascular Treatment for Acute Basilar Artery Occlusion)/ATTENTION-IA (Intra-Arterial Tenecteplase After Successful Endovascular Recanalisation in Patients With Acute Posterior Circulation Arterial Occlusion) trials included patients with posterior circulation occlusion who underwent mechanical thrombectomy and had baseline computed tomography perfusion. HIR (Tmax>10 s/ Tmax>6 s volume) was analyzed. Functional independence (modified Rankin Scale score, 0-2) at 90 days was the primary outcome.Results

Among 139 patients, higher HIR (per 0.1 increment) was independently associated with lower odds of 90-day modified Rankin Scale score of 0 to 2 (adjusted odds ratio, 0.643 [95% CI, 0.422-0.979]; P=0.039). However, its discriminative ability was the modest (area under the curve, 0.617 [95% CI, 0.521-0.712]). The established anterior circulation cutoff (HIR<0.4) did not predict outcomes (P=0.115).Conclusions

Elevated HIR is independently associated with worse 90-day outcomes after posterior circulation mechanical thrombectomy, but its overall prognostic utility is limited, and the anterior circulation threshold (0.4) could not be validated in this underpowered analysis, highlighting circulation-specific pathophysiological differences.

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Cite

BibTeX RIS

BibTeX

@article{mo2026association,
  title = {{Association Between Hypoperfusion Intensity Ratio and Outcomes After Endovascular Thrombectomy in Posterior Circulation Stroke: A Retrospective Study}},
  author = {Ming Mo and Chun Rong Tao and Chun Yu Yu and Zhong Jun Chen and Wei Hu},
  journal = {Stroke (Hoboken, N.J.)},
  year = {2026},
  month = nov,
  doi = {10.1161/svin.125.002305},
  url = {https://europepmc.org/article/PMC/PMC13727208},
  note = {CC BY-NC},
}

RIS

TY  - JOUR
TI  - Association Between Hypoperfusion Intensity Ratio and Outcomes After Endovascular Thrombectomy in Posterior Circulation Stroke: A Retrospective Study
AU  - Ming Mo
AU  - Chun Rong Tao
AU  - Chun Yu Yu
AU  - Zhong Jun Chen
AU  - Wei Hu
PY  - 2026
DA  - 2026/11/01
JO  - Stroke (Hoboken, N.J.)
DO  - 10.1161/svin.125.002305
UR  - https://europepmc.org/article/PMC/PMC13727208
AB  - Background  The prognostic utility of the hypoperfusion intensity ratio (HIR) in posterior circulation stroke is undefined. We investigated the association between pretreatment HIR and outcomes after mechanical thrombectomy for acute posterior circulation large vessel occlusion.Methods  This post hoc analysis of the ATTENTION (Endovascular Treatment for Acute Basilar Artery Occlusion)/ATTENTION-IA (Intra-Arterial Tenecteplase After Successful Endovascular Recanalisation in Patients With Acute Posterior Circulation Arterial Occlusion) trials included patients with posterior circulation occlusion who underwent mechanical thrombectomy and had baseline computed tomography perfusion. HIR (Tmax>10 s/ Tmax>6 s volume) was analyzed. Functional independence (modified Rankin Scale score, 0-2) at 90 days was the primary outcome.Results  Among 139 patients, higher HIR (per 0.1 increment) was independently associated with lower odds of 90-day modified Rankin Scale score of 0 to 2 (adjusted odds ratio, 0.643 [95% CI, 0.422-0.979]; P=0.039). However, its discriminative ability was the modest (area under the curve, 0.617 [95% CI, 0.521-0.712]). The established anterior circulation cutoff (HIR<0.4) did not predict outcomes (P=0.115).Conclusions  Elevated HIR is independently associated with worse 90-day outcomes after posterior circulation mechanical thrombectomy, but its overall prognostic utility is limited, and the anterior circulation threshold (0.4) could not be validated in this underpowered analysis, highlighting circulation-specific pathophysiological differences.
SN  - 2694-5746
ER  -

Abstract

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