Perfusion imaging-based tissue-level collaterals predict ischemic lesion net water uptake in patients with acute ischemic stroke and large vessel occlusion

J Cereb Blood Flow Metab. 2021 Aug;41(8):2067-2075. doi: 10.1177/0271678X21992200. Epub 2021 Feb 8.


Ischemic lesion Net Water Uptake (NWU) quantifies cerebral edema formation and likely correlates with the microvascular perfusion status of patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO). We hypothesized that favorable tissue-level collaterals (TLC) predict less NWU and good functional outcomes. We performed a retrospective multicenter analysis of AIS-LVO patients who underwent thrombectomy triage. TLC were measured on cerebral perfusion studies using the hypoperfusion intensity ratio (HIR; volume ratio of brain tissue with [Tmax > 10 sec/Tmax > 6 sec]); favorable TLC were regarded as HIR 0.4. NWU was determined using a quantitative densitometry approach on follow-up CT. Primary outcome was NWU. Secondary outcome was a good functional outcome (modified Rankin Scale [mRS] 0-2).580 patients met inclusion criteria. Favorable TLC (β: 4.23, SE: 0.65; p < 0.001) predicted smaller NWU after treatment. Favorable TLC (OR: 2.35, [95% CI: 1.31-4.21]; p < 0.001), and decreased NWU (OR: 0.75, [95% CI: 0.70-0.79]; p < 0.001) predicted good functional outcome, while controlling for age, glucose, CTA collaterals, baseline NIHSS and good vessel reperfusion status.We conclude that favorable TLC predict less ischemic lesion NWU after treatment in AIS-LVO patients. Favorable TLC and decreased NWU were independent predictors of good functional outcome.

Keywords: Collateral circulation; ischemic edema; net water uptake; perfusion imaging; tissue perfusion.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Aged
  • Aged, 80 and over
  • Brain / blood supply
  • Brain / diagnostic imaging
  • Collateral Circulation
  • Female
  • Humans
  • Ischemic Stroke / diagnostic imaging
  • Ischemic Stroke / drug therapy
  • Ischemic Stroke / pathology*
  • Ischemic Stroke / surgery
  • Logistic Models
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Odds Ratio
  • Perfusion Imaging / methods*
  • Retrospective Studies
  • Thrombectomy
  • Tissue Plasminogen Activator / therapeutic use
  • Tomography, X-Ray Computed


  • Tissue Plasminogen Activator