AUTHOR=Chen Pengjun , Li Xia , Huang Yechao , Hui Junguo , Rao Jie , Zhang Wenya , Shang Lijun , Chen Xiao , Gao Ruijie , Zhou Jinwei , Xia Shuiwei , Ding Qiaoling , Ji Jiansong 

TITLE=Accuracy of computed tomography perfusion-defined ischemic core and follow-up infarction after basilar artery thrombectomy

JOURNAL=Frontiers in Neurology

VOLUME=Volume 16 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2025.1678450

DOI=10.3389/fneur.2025.1678450

ISSN=1664-2295

ABSTRACT=PurposeAccurate identification of computed tomography (CT) perfusion ischemic core in patients with basilar artery occlusion (BAO) on admission remains challenging despite its critical role in prognostic prediction and treatment decision-making. We aimed to define the optimal threshold for identifying the ischemic core by assessing agreement in lesion extent and spatial distribution using Syngo.via.MethodsWe retrospectively analyzed 91 patients with BAO who achieved successful recanalization after endovascular thrombectomy at our center. The ischemic core was estimated using the following thresholds: cerebral blood flow (CBF) < 10 or 15 mL/100 g/min by Syngo.via, cerebral blood volume < 1.2 mL/100 mL by Syngo.via, and time to maximum > 10 s by RAPID. The Posterior Circulation Alberta Stroke Program Early CT Score was used to assess the extent of the infarction. Statistical analyses included the intraclass correlation coefficient (ICC) and receiver operating characteristic analyses.ResultsThe CBF < 10 mL/100 g/min threshold demonstrated good agreement in extent with follow-up infarction (ICC: 0.81 [95% confidence intervals 0.72–0.87]), with overestimation or underestimation being the most uncommon (n = 9). For the detection of midbrain, pontine, and cerebellar infarction, this threshold yielded the best performance with the area under the curve ranging from 0.79 (midbrain, 0.66–0.93; p < 0.001) to 0.90 (pons, 0.83–0.98; p < 0.001).ConclusionIn patients with BAO after successful recanalization, the optimal threshold for the ischemic core was a CBF < 10 mL/100 g/min. This threshold may serve as a reliable imaging biomarker, aiding in the prediction of tissue outcomes and treatment decision-making.