Post-Endovascular Thrombectomy Perfusion Imaging (CT and MR) as a Prognostic Biomarker and Patient-Selection…

Cohort studyJournal of stroke and cerebrovascular diseases : the official journal of National Stroke Association· Aug 2026

Post-Endovascular Thrombectomy Perfusion Imaging (CT and MR) as a Prognostic Biomarker and Patient-Selection Tool for Adjuvant Therapy: A Systematic Review, Meta-Analysis, and Clinical Threshold Framework.

Roni Eichel, Michael Teitcher, Stefan Mausbach … Natan Bornstein

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NeuroendovascularCohort studyPrognosisQ1IF 2.1

Residual hypoperfusion after thrombectomy is associated with lower odds of functional independence

Post-Endovascular Thrombectomy Perfusion Imaging (CT and MR) as a Prognostic Biomarker and Patient-Selection Tool for Adjuvant Therapy: A Systematic Review, Meta-Analysis, and Clinical Threshold Framework.

Roni Eichel … Natan Bornstein

Journal of stroke and cerebrovascular diseases · Aug 2026 · Q1 in Surgery

Background

Despite high rates of macrovascular recanalization, approximately half of patients with large vessel occlusion stroke fail to achieve functional independence after endovascular thrombectomy (endovascular thrombectomy).

Purpose

We aimed to establish post-endovascular thrombectomy perfusion imaging (by CT or MR perfusion) as a surrogate marker predictive of functional independence on the modified Rankin Scale - by synthesizing evidence-based perfusion thresholds and defining the optimal acquisition timing.

Methods

We systematically searched MEDLINE, EMBASE, and the Cochrane Library from January 2018 through April 2026 for cohort studies performing perfusion imaging after endovascular thrombectomy, reporting at least one quantitative CT- or MR-perfusion parameter alongside functional outcome (modified Rankin Scale [mRS] at any post-procedural time point) or neurological outcome (National Institutes of Health Stroke Scale [NIHSS]), and enrolling ≥10 patients.

n = 670 patients

Results

residual hypoperfusion sharply lowers odds of functional independence

OR by subgroup · 95% CI

More results

Eight independent post-endovascular thrombectomy perfusion imaging studies (670 patients; five CT-perfusion, two MR-perfusion, and one mixed CT/MR cohort) met inclusion criteria.

More results

The pre-specified sensitivity analysis excluding the cerebrolysin-treated cohort yielded a pooled OR of 0.30 (95% CI 0.16-0.54; I²=0%), confirming that the pooled effect is not driven by the adjuvant-treated subgroup.

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Conclusion · 1 of 2

Post-endovascular thrombectomy perfusion imaging (CT or MR) provides tissue-level reperfusion information that complements modified Thrombolysis in Cerebral Infarction (mTICI) grading and identifies biologically distinct patient subgroups.

Conclusion · 2 of 2

Standardized post-endovascular thrombectomy perfusion imaging at 30-120 minutes, applied with the proposed threshold framework, should be considered as an eligibility criterion and stratification variable in future trials of post-endovascular thrombectomy adjuvant therapy across the pharmacological spectrum.

Post-Endovascular Thrombectomy Perfusion Imaging (CT and MR) as a Prognostic Biomarker and Patient-Selection Tool for Adjuvant Therapy: A Systematic Review, Meta-Analysis, and Clinical Threshold Framework.

Post-Endovascular Thrombectomy Perfusion Imaging (CT and MR) as a Prognostic Biomarker and Patient-Selection Tool for Adjuvant Therapy: A Systematic Review, Meta-Analysis, and Clinical Threshold Framework.

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