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Background <p>Successful macrovascular recanalization after mechanical thrombectomy (MT) does not always ensure tissue-level microvascular reperfusion, highlighting the need for reliable preoperative imaging biomarkers to predict microvascular success.</p> Aims <p>To investigate whether the preoperative volume of mildly delay time (DT 2–4&#xa0;s), as quantified by MIStar CT perfusion (CTP), can predict 24-hour complete reperfusion (CR) in patients achieving successful MT.</p> Methods <p>We retrospectively analyzed patients with acute anterior circulation large vessel occlusion treated between January 2015 and December 2022 who achieved successful recanalization (eTICI 2b-3). All participants received baseline and follow-up CTP at 24&#xa0;h processed by MIStar. CR was defined as 100% reperfusion on follow-up imaging. The relationship between preoperative DT 2–4&#xa0;s volume and CR was evaluated using multivariable logistic regression and Receiver Operating Characteristic (ROC) curve analysis.</p> Results <p>Sixty patients (mean age 65 years, 58.3% male) were included, with 36 (60%) achieving CR. Preoperative DT 2–4&#xa0;s volume was significantly smaller in the CR group (64.8 ± 27.2&#xa0;ml) compared to the incomplete group (113.5 ± 52.3&#xa0;ml; <i>p</i> &lt; 0.001). After adjusting for confounders, DT 2–4&#xa0;s remained independently associated with CR (adjusted OR 0.94; 95% CI 0.9 to 0.98). ROC analysis yielded an AUC of 0.81. A threshold of DT 2–4&#xa0;s &lt; 95&#xa0;ml predicted CR with a sensitivity of 0.84, a specificity of 0.81.</p> Conclusion <p>Preoperative DT 2–4&#xa0;s volume is a novel and sensitive biomarker for predicting 24-hour complete tissue-level reperfusion. It identifies patients at risk of microvascular failure despite successful large-vessel recanalization.</p>

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Preoperative volume of mildly delayed time predicts 24-hour complete reperfusion after successful mechanical thrombectomy

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  • 发表日期：

    2026年7月2日

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  • Hui Zhang,
  • Yimeng Liu,
  • Hongchen Zhao,
  • Yifeng Ling,
  • Qiang Dong,
  • Wenjie Cao

摘要

Background

Successful macrovascular recanalization after mechanical thrombectomy (MT) does not always ensure tissue-level microvascular reperfusion, highlighting the need for reliable preoperative imaging biomarkers to predict microvascular success.

Aims

To investigate whether the preoperative volume of mildly delay time (DT 2–4 s), as quantified by MIStar CT perfusion (CTP), can predict 24-hour complete reperfusion (CR) in patients achieving successful MT.

Methods

We retrospectively analyzed patients with acute anterior circulation large vessel occlusion treated between January 2015 and December 2022 who achieved successful recanalization (eTICI 2b-3). All participants received baseline and follow-up CTP at 24 h processed by MIStar. CR was defined as 100% reperfusion on follow-up imaging. The relationship between preoperative DT 2–4 s volume and CR was evaluated using multivariable logistic regression and Receiver Operating Characteristic (ROC) curve analysis.

Results

Sixty patients (mean age 65 years, 58.3% male) were included, with 36 (60%) achieving CR. Preoperative DT 2–4 s volume was significantly smaller in the CR group (64.8 ± 27.2 ml) compared to the incomplete group (113.5 ± 52.3 ml; p < 0.001). After adjusting for confounders, DT 2–4 s remained independently associated with CR (adjusted OR 0.94; 95% CI 0.9 to 0.98). ROC analysis yielded an AUC of 0.81. A threshold of DT 2–4 s < 95 ml predicted CR with a sensitivity of 0.84, a specificity of 0.81.

Conclusion

Preoperative DT 2–4 s volume is a novel and sensitive biomarker for predicting 24-hour complete tissue-level reperfusion. It identifies patients at risk of microvascular failure despite successful large-vessel recanalization.