Abstract WMP69: Association Between Computed Tomography Perfusion Parameters and Functional Independence in Acute Ischemic Stroke Post-Endovascular Therapy: A Secondary Analysis from the SELECT Study

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Introduction: Cerebral computed tomography perfusion (CTP) imaging has been well-established for identifying candidates for endovascular therapy (EVT) in acute ischemic stroke. This study investigates the association between CTP parameters and functional independence post-EVT using data from the SELECT study. Methods: We analyzed baseline CTP images from SELECT patients, focusing on those with available cerebral blood volume (CBV), cerebral blood flow (CBF), and time to maximum perfusion (Tmax) maps. Patients who received EVT and medical management only (MM) were included. Logistic regression models were created with age, national institutes of health stroke scale (NIHSS), time to arrival, occlusion location, transfer status, and CT ASPECTS as covariates, and functional independence at 90 days (modified Rankin score 0-2) as the outcome. Receiver operating characteristic (ROC) curves were generated, and area under the curve (AUC) values were calculated and compared using DeLong’s test. Results: Among 361 patients, 171 (139 EVT, 32 MM) had volumetric estimates for CTP parameters with pre-defined thresholds. Median (IQR) age and NIHSS were 68 (56-78) and 16 (12-20), and 48% were females. Estimates of different thresholds within a given CTP parameter showed high correlation (>0.8), and a moderate to high correlation (>0.4-0.6) was observed in estimates across different parameters (all p<0.05, figure 1). ROC curves revealed AUC values >0.7 for all CTP parameters in both EVT (figure 2) and combined (EVT + MM, figure 3) subgroups, with the highest values for CBF thresholds: <30% [EVT – AUC 0.7507, combined – AUC 0.8028], <34% [EVT – AUC 0.737, combined – AUC 0.7857] and <38% [EVT - AUC 0.7351, combined – AUC 0.7831], followed by CBV parameters and then Tmax parameters. No significant differences were found between AUC values of different CTP parameters (EVT: p=0.88; combined: p=0.46). Conclusion: All CTP parameters demonstrated high AUC values (>0.7) for functional independence at 90 days in acute stroke patients, particularly CBF <30%, indicating their potential as prognostic markers.

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