Review ArticleReview Articles
Role of Hypoperfusion Intensity Ratio in Vessel Occlusions: A Review on Safety and Clinical Outcomes
Sana Rehman, Arsalan Nadeem, Arbab Burhan Uddin Kasi, Ali Husnain, Summaiyya Waseem, Sohail Kumar, Syed Muhammad Owais, Nasreen Banu, Dhairya A. Lakhani, Hamza A. Salim, Risheng Xu, Vaibhav S. Vagal, Yasmin N. Aziz, Argye E. Hillis, Victor C. Urrutia, Rafael H. Llinas, Elisabeth B. Marsh, Richard Leigh, Hanzhang Lu, Adam A. Dmytriw, Adrien Guenego, Gregory W. Albers, Jeremy J. Heit, Tobias D. Faizy and Vivek S. Yedavalli
American Journal of Neuroradiology October 2024, ajnr.A8557; DOI: https://doi.org/10.3174/ajnr.A8557
Sana Rehman
From the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., V.S.Y.), Johns Hopkins University, Baltimore, Maryland, U.S.; Department of Medicine (A.N.), Allama Iqbal Medical College, Lahore, Punjab, Pakistan; Mass General Brigham (A.B.U.K.), Massachusetts, U.S.; Division of Interventional Radiology, Department of Radiology (A.H.), Northwestern Memorial Hospital, Chicago, Illinois, U.S.; Dow University of Health Sciences (S.W.), Karachi, Pakistan; HMH JFK University Medical Center (S.K.), Edison, New Jersey, U.S.; University of Toledo (S.M.O.), Toledo, Ohio, U.S.; Shadan Institute of Medical Sciences (N.B.), Hyderabad, Telangana, India; Stony Brook University Renaissance School of Medicine (V.S.V), New York, U.S.; University of Cincinnati College of Medicine (Y.N.A.), Cincinnati, Ohio, U.S.; Department of Neurology (R.L.), Johns Hopkins Medicine, Baltimore, Maryland, U.S.; Neuroendovascular Program (A.A.D.), Massachusetts General Hospital, Boston, Massachusetts, U.S.; Department of Diagnostic and Interventional Neuroradiology (A.G.), Erasme University Hospital, Brussels, Belgium; Department of Neurology (G.W.A., J.J.H.), Stanford University, Stanford, California, U.S.; Department of Radiology (T.D.F.), Neuroendovascular Program, University Medical Center Münster, Munster, Germany.
Arsalan Nadeem
From the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., V.S.Y.), Johns Hopkins University, Baltimore, Maryland, U.S.; Department of Medicine (A.N.), Allama Iqbal Medical College, Lahore, Punjab, Pakistan; Mass General Brigham (A.B.U.K.), Massachusetts, U.S.; Division of Interventional Radiology, Department of Radiology (A.H.), Northwestern Memorial Hospital, Chicago, Illinois, U.S.; Dow University of Health Sciences (S.W.), Karachi, Pakistan; HMH JFK University Medical Center (S.K.), Edison, New Jersey, U.S.; University of Toledo (S.M.O.), Toledo, Ohio, U.S.; Shadan Institute of Medical Sciences (N.B.), Hyderabad, Telangana, India; Stony Brook University Renaissance School of Medicine (V.S.V), New York, U.S.; University of Cincinnati College of Medicine (Y.N.A.), Cincinnati, Ohio, U.S.; Department of Neurology (R.L.), Johns Hopkins Medicine, Baltimore, Maryland, U.S.; Neuroendovascular Program (A.A.D.), Massachusetts General Hospital, Boston, Massachusetts, U.S.; Department of Diagnostic and Interventional Neuroradiology (A.G.), Erasme University Hospital, Brussels, Belgium; Department of Neurology (G.W.A., J.J.H.), Stanford University, Stanford, California, U.S.; Department of Radiology (T.D.F.), Neuroendovascular Program, University Medical Center Münster, Munster, Germany.
Arbab Burhan Uddin Kasi
From the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., V.S.Y.), Johns Hopkins University, Baltimore, Maryland, U.S.; Department of Medicine (A.N.), Allama Iqbal Medical College, Lahore, Punjab, Pakistan; Mass General Brigham (A.B.U.K.), Massachusetts, U.S.; Division of Interventional Radiology, Department of Radiology (A.H.), Northwestern Memorial Hospital, Chicago, Illinois, U.S.; Dow University of Health Sciences (S.W.), Karachi, Pakistan; HMH JFK University Medical Center (S.K.), Edison, New Jersey, U.S.; University of Toledo (S.M.O.), Toledo, Ohio, U.S.; Shadan Institute of Medical Sciences (N.B.), Hyderabad, Telangana, India; Stony Brook University Renaissance School of Medicine (V.S.V), New York, U.S.; University of Cincinnati College of Medicine (Y.N.A.), Cincinnati, Ohio, U.S.; Department of Neurology (R.L.), Johns Hopkins Medicine, Baltimore, Maryland, U.S.; Neuroendovascular Program (A.A.D.), Massachusetts General Hospital, Boston, Massachusetts, U.S.; Department of Diagnostic and Interventional Neuroradiology (A.G.), Erasme University Hospital, Brussels, Belgium; Department of Neurology (G.W.A., J.J.H.), Stanford University, Stanford, California, U.S.; Department of Radiology (T.D.F.), Neuroendovascular Program, University Medical Center Münster, Munster, Germany.
Ali Husnain
From the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., V.S.Y.), Johns Hopkins University, Baltimore, Maryland, U.S.; Department of Medicine (A.N.), Allama Iqbal Medical College, Lahore, Punjab, Pakistan; Mass General Brigham (A.B.U.K.), Massachusetts, U.S.; Division of Interventional Radiology, Department of Radiology (A.H.), Northwestern Memorial Hospital, Chicago, Illinois, U.S.; Dow University of Health Sciences (S.W.), Karachi, Pakistan; HMH JFK University Medical Center (S.K.), Edison, New Jersey, U.S.; University of Toledo (S.M.O.), Toledo, Ohio, U.S.; Shadan Institute of Medical Sciences (N.B.), Hyderabad, Telangana, India; Stony Brook University Renaissance School of Medicine (V.S.V), New York, U.S.; University of Cincinnati College of Medicine (Y.N.A.), Cincinnati, Ohio, U.S.; Department of Neurology (R.L.), Johns Hopkins Medicine, Baltimore, Maryland, U.S.; Neuroendovascular Program (A.A.D.), Massachusetts General Hospital, Boston, Massachusetts, U.S.; Department of Diagnostic and Interventional Neuroradiology (A.G.), Erasme University Hospital, Brussels, Belgium; Department of Neurology (G.W.A., J.J.H.), Stanford University, Stanford, California, U.S.; Department of Radiology (T.D.F.), Neuroendovascular Program, University Medical Center Münster, Munster, Germany.
Summaiyya Waseem
From the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., V.S.Y.), Johns Hopkins University, Baltimore, Maryland, U.S.; Department of Medicine (A.N.), Allama Iqbal Medical College, Lahore, Punjab, Pakistan; Mass General Brigham (A.B.U.K.), Massachusetts, U.S.; Division of Interventional Radiology, Department of Radiology (A.H.), Northwestern Memorial Hospital, Chicago, Illinois, U.S.; Dow University of Health Sciences (S.W.), Karachi, Pakistan; HMH JFK University Medical Center (S.K.), Edison, New Jersey, U.S.; University of Toledo (S.M.O.), Toledo, Ohio, U.S.; Shadan Institute of Medical Sciences (N.B.), Hyderabad, Telangana, India; Stony Brook University Renaissance School of Medicine (V.S.V), New York, U.S.; University of Cincinnati College of Medicine (Y.N.A.), Cincinnati, Ohio, U.S.; Department of Neurology (R.L.), Johns Hopkins Medicine, Baltimore, Maryland, U.S.; Neuroendovascular Program (A.A.D.), Massachusetts General Hospital, Boston, Massachusetts, U.S.; Department of Diagnostic and Interventional Neuroradiology (A.G.), Erasme University Hospital, Brussels, Belgium; Department of Neurology (G.W.A., J.J.H.), Stanford University, Stanford, California, U.S.; Department of Radiology (T.D.F.), Neuroendovascular Program, University Medical Center Münster, Munster, Germany.
Sohail Kumar
From the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., V.S.Y.), Johns Hopkins University, Baltimore, Maryland, U.S.; Department of Medicine (A.N.), Allama Iqbal Medical College, Lahore, Punjab, Pakistan; Mass General Brigham (A.B.U.K.), Massachusetts, U.S.; Division of Interventional Radiology, Department of Radiology (A.H.), Northwestern Memorial Hospital, Chicago, Illinois, U.S.; Dow University of Health Sciences (S.W.), Karachi, Pakistan; HMH JFK University Medical Center (S.K.), Edison, New Jersey, U.S.; University of Toledo (S.M.O.), Toledo, Ohio, U.S.; Shadan Institute of Medical Sciences (N.B.), Hyderabad, Telangana, India; Stony Brook University Renaissance School of Medicine (V.S.V), New York, U.S.; University of Cincinnati College of Medicine (Y.N.A.), Cincinnati, Ohio, U.S.; Department of Neurology (R.L.), Johns Hopkins Medicine, Baltimore, Maryland, U.S.; Neuroendovascular Program (A.A.D.), Massachusetts General Hospital, Boston, Massachusetts, U.S.; Department of Diagnostic and Interventional Neuroradiology (A.G.), Erasme University Hospital, Brussels, Belgium; Department of Neurology (G.W.A., J.J.H.), Stanford University, Stanford, California, U.S.; Department of Radiology (T.D.F.), Neuroendovascular Program, University Medical Center Münster, Munster, Germany.
Syed Muhammad Owais
From the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., V.S.Y.), Johns Hopkins University, Baltimore, Maryland, U.S.; Department of Medicine (A.N.), Allama Iqbal Medical College, Lahore, Punjab, Pakistan; Mass General Brigham (A.B.U.K.), Massachusetts, U.S.; Division of Interventional Radiology, Department of Radiology (A.H.), Northwestern Memorial Hospital, Chicago, Illinois, U.S.; Dow University of Health Sciences (S.W.), Karachi, Pakistan; HMH JFK University Medical Center (S.K.), Edison, New Jersey, U.S.; University of Toledo (S.M.O.), Toledo, Ohio, U.S.; Shadan Institute of Medical Sciences (N.B.), Hyderabad, Telangana, India; Stony Brook University Renaissance School of Medicine (V.S.V), New York, U.S.; University of Cincinnati College of Medicine (Y.N.A.), Cincinnati, Ohio, U.S.; Department of Neurology (R.L.), Johns Hopkins Medicine, Baltimore, Maryland, U.S.; Neuroendovascular Program (A.A.D.), Massachusetts General Hospital, Boston, Massachusetts, U.S.; Department of Diagnostic and Interventional Neuroradiology (A.G.), Erasme University Hospital, Brussels, Belgium; Department of Neurology (G.W.A., J.J.H.), Stanford University, Stanford, California, U.S.; Department of Radiology (T.D.F.), Neuroendovascular Program, University Medical Center Münster, Munster, Germany.
Nasreen Banu
From the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., V.S.Y.), Johns Hopkins University, Baltimore, Maryland, U.S.; Department of Medicine (A.N.), Allama Iqbal Medical College, Lahore, Punjab, Pakistan; Mass General Brigham (A.B.U.K.), Massachusetts, U.S.; Division of Interventional Radiology, Department of Radiology (A.H.), Northwestern Memorial Hospital, Chicago, Illinois, U.S.; Dow University of Health Sciences (S.W.), Karachi, Pakistan; HMH JFK University Medical Center (S.K.), Edison, New Jersey, U.S.; University of Toledo (S.M.O.), Toledo, Ohio, U.S.; Shadan Institute of Medical Sciences (N.B.), Hyderabad, Telangana, India; Stony Brook University Renaissance School of Medicine (V.S.V), New York, U.S.; University of Cincinnati College of Medicine (Y.N.A.), Cincinnati, Ohio, U.S.; Department of Neurology (R.L.), Johns Hopkins Medicine, Baltimore, Maryland, U.S.; Neuroendovascular Program (A.A.D.), Massachusetts General Hospital, Boston, Massachusetts, U.S.; Department of Diagnostic and Interventional Neuroradiology (A.G.), Erasme University Hospital, Brussels, Belgium; Department of Neurology (G.W.A., J.J.H.), Stanford University, Stanford, California, U.S.; Department of Radiology (T.D.F.), Neuroendovascular Program, University Medical Center Münster, Munster, Germany.
Dhairya A. Lakhani
From the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., V.S.Y.), Johns Hopkins University, Baltimore, Maryland, U.S.; Department of Medicine (A.N.), Allama Iqbal Medical College, Lahore, Punjab, Pakistan; Mass General Brigham (A.B.U.K.), Massachusetts, U.S.; Division of Interventional Radiology, Department of Radiology (A.H.), Northwestern Memorial Hospital, Chicago, Illinois, U.S.; Dow University of Health Sciences (S.W.), Karachi, Pakistan; HMH JFK University Medical Center (S.K.), Edison, New Jersey, U.S.; University of Toledo (S.M.O.), Toledo, Ohio, U.S.; Shadan Institute of Medical Sciences (N.B.), Hyderabad, Telangana, India; Stony Brook University Renaissance School of Medicine (V.S.V), New York, U.S.; University of Cincinnati College of Medicine (Y.N.A.), Cincinnati, Ohio, U.S.; Department of Neurology (R.L.), Johns Hopkins Medicine, Baltimore, Maryland, U.S.; Neuroendovascular Program (A.A.D.), Massachusetts General Hospital, Boston, Massachusetts, U.S.; Department of Diagnostic and Interventional Neuroradiology (A.G.), Erasme University Hospital, Brussels, Belgium; Department of Neurology (G.W.A., J.J.H.), Stanford University, Stanford, California, U.S.; Department of Radiology (T.D.F.), Neuroendovascular Program, University Medical Center Münster, Munster, Germany.
Hamza A. Salim
From the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., V.S.Y.), Johns Hopkins University, Baltimore, Maryland, U.S.; Department of Medicine (A.N.), Allama Iqbal Medical College, Lahore, Punjab, Pakistan; Mass General Brigham (A.B.U.K.), Massachusetts, U.S.; Division of Interventional Radiology, Department of Radiology (A.H.), Northwestern Memorial Hospital, Chicago, Illinois, U.S.; Dow University of Health Sciences (S.W.), Karachi, Pakistan; HMH JFK University Medical Center (S.K.), Edison, New Jersey, U.S.; University of Toledo (S.M.O.), Toledo, Ohio, U.S.; Shadan Institute of Medical Sciences (N.B.), Hyderabad, Telangana, India; Stony Brook University Renaissance School of Medicine (V.S.V), New York, U.S.; University of Cincinnati College of Medicine (Y.N.A.), Cincinnati, Ohio, U.S.; Department of Neurology (R.L.), Johns Hopkins Medicine, Baltimore, Maryland, U.S.; Neuroendovascular Program (A.A.D.), Massachusetts General Hospital, Boston, Massachusetts, U.S.; Department of Diagnostic and Interventional Neuroradiology (A.G.), Erasme University Hospital, Brussels, Belgium; Department of Neurology (G.W.A., J.J.H.), Stanford University, Stanford, California, U.S.; Department of Radiology (T.D.F.), Neuroendovascular Program, University Medical Center Münster, Munster, Germany.
Risheng Xu
From the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., V.S.Y.), Johns Hopkins University, Baltimore, Maryland, U.S.; Department of Medicine (A.N.), Allama Iqbal Medical College, Lahore, Punjab, Pakistan; Mass General Brigham (A.B.U.K.), Massachusetts, U.S.; Division of Interventional Radiology, Department of Radiology (A.H.), Northwestern Memorial Hospital, Chicago, Illinois, U.S.; Dow University of Health Sciences (S.W.), Karachi, Pakistan; HMH JFK University Medical Center (S.K.), Edison, New Jersey, U.S.; University of Toledo (S.M.O.), Toledo, Ohio, U.S.; Shadan Institute of Medical Sciences (N.B.), Hyderabad, Telangana, India; Stony Brook University Renaissance School of Medicine (V.S.V), New York, U.S.; University of Cincinnati College of Medicine (Y.N.A.), Cincinnati, Ohio, U.S.; Department of Neurology (R.L.), Johns Hopkins Medicine, Baltimore, Maryland, U.S.; Neuroendovascular Program (A.A.D.), Massachusetts General Hospital, Boston, Massachusetts, U.S.; Department of Diagnostic and Interventional Neuroradiology (A.G.), Erasme University Hospital, Brussels, Belgium; Department of Neurology (G.W.A., J.J.H.), Stanford University, Stanford, California, U.S.; Department of Radiology (T.D.F.), Neuroendovascular Program, University Medical Center Münster, Munster, Germany.
Vaibhav S. Vagal
From the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., V.S.Y.), Johns Hopkins University, Baltimore, Maryland, U.S.; Department of Medicine (A.N.), Allama Iqbal Medical College, Lahore, Punjab, Pakistan; Mass General Brigham (A.B.U.K.), Massachusetts, U.S.; Division of Interventional Radiology, Department of Radiology (A.H.), Northwestern Memorial Hospital, Chicago, Illinois, U.S.; Dow University of Health Sciences (S.W.), Karachi, Pakistan; HMH JFK University Medical Center (S.K.), Edison, New Jersey, U.S.; University of Toledo (S.M.O.), Toledo, Ohio, U.S.; Shadan Institute of Medical Sciences (N.B.), Hyderabad, Telangana, India; Stony Brook University Renaissance School of Medicine (V.S.V), New York, U.S.; University of Cincinnati College of Medicine (Y.N.A.), Cincinnati, Ohio, U.S.; Department of Neurology (R.L.), Johns Hopkins Medicine, Baltimore, Maryland, U.S.; Neuroendovascular Program (A.A.D.), Massachusetts General Hospital, Boston, Massachusetts, U.S.; Department of Diagnostic and Interventional Neuroradiology (A.G.), Erasme University Hospital, Brussels, Belgium; Department of Neurology (G.W.A., J.J.H.), Stanford University, Stanford, California, U.S.; Department of Radiology (T.D.F.), Neuroendovascular Program, University Medical Center Münster, Munster, Germany.
Yasmin N. Aziz
From the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., V.S.Y.), Johns Hopkins University, Baltimore, Maryland, U.S.; Department of Medicine (A.N.), Allama Iqbal Medical College, Lahore, Punjab, Pakistan; Mass General Brigham (A.B.U.K.), Massachusetts, U.S.; Division of Interventional Radiology, Department of Radiology (A.H.), Northwestern Memorial Hospital, Chicago, Illinois, U.S.; Dow University of Health Sciences (S.W.), Karachi, Pakistan; HMH JFK University Medical Center (S.K.), Edison, New Jersey, U.S.; University of Toledo (S.M.O.), Toledo, Ohio, U.S.; Shadan Institute of Medical Sciences (N.B.), Hyderabad, Telangana, India; Stony Brook University Renaissance School of Medicine (V.S.V), New York, U.S.; University of Cincinnati College of Medicine (Y.N.A.), Cincinnati, Ohio, U.S.; Department of Neurology (R.L.), Johns Hopkins Medicine, Baltimore, Maryland, U.S.; Neuroendovascular Program (A.A.D.), Massachusetts General Hospital, Boston, Massachusetts, U.S.; Department of Diagnostic and Interventional Neuroradiology (A.G.), Erasme University Hospital, Brussels, Belgium; Department of Neurology (G.W.A., J.J.H.), Stanford University, Stanford, California, U.S.; Department of Radiology (T.D.F.), Neuroendovascular Program, University Medical Center Münster, Munster, Germany.
Argye E. Hillis
From the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., V.S.Y.), Johns Hopkins University, Baltimore, Maryland, U.S.; Department of Medicine (A.N.), Allama Iqbal Medical College, Lahore, Punjab, Pakistan; Mass General Brigham (A.B.U.K.), Massachusetts, U.S.; Division of Interventional Radiology, Department of Radiology (A.H.), Northwestern Memorial Hospital, Chicago, Illinois, U.S.; Dow University of Health Sciences (S.W.), Karachi, Pakistan; HMH JFK University Medical Center (S.K.), Edison, New Jersey, U.S.; University of Toledo (S.M.O.), Toledo, Ohio, U.S.; Shadan Institute of Medical Sciences (N.B.), Hyderabad, Telangana, India; Stony Brook University Renaissance School of Medicine (V.S.V), New York, U.S.; University of Cincinnati College of Medicine (Y.N.A.), Cincinnati, Ohio, U.S.; Department of Neurology (R.L.), Johns Hopkins Medicine, Baltimore, Maryland, U.S.; Neuroendovascular Program (A.A.D.), Massachusetts General Hospital, Boston, Massachusetts, U.S.; Department of Diagnostic and Interventional Neuroradiology (A.G.), Erasme University Hospital, Brussels, Belgium; Department of Neurology (G.W.A., J.J.H.), Stanford University, Stanford, California, U.S.; Department of Radiology (T.D.F.), Neuroendovascular Program, University Medical Center Münster, Munster, Germany.
Victor C. Urrutia
From the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., V.S.Y.), Johns Hopkins University, Baltimore, Maryland, U.S.; Department of Medicine (A.N.), Allama Iqbal Medical College, Lahore, Punjab, Pakistan; Mass General Brigham (A.B.U.K.), Massachusetts, U.S.; Division of Interventional Radiology, Department of Radiology (A.H.), Northwestern Memorial Hospital, Chicago, Illinois, U.S.; Dow University of Health Sciences (S.W.), Karachi, Pakistan; HMH JFK University Medical Center (S.K.), Edison, New Jersey, U.S.; University of Toledo (S.M.O.), Toledo, Ohio, U.S.; Shadan Institute of Medical Sciences (N.B.), Hyderabad, Telangana, India; Stony Brook University Renaissance School of Medicine (V.S.V), New York, U.S.; University of Cincinnati College of Medicine (Y.N.A.), Cincinnati, Ohio, U.S.; Department of Neurology (R.L.), Johns Hopkins Medicine, Baltimore, Maryland, U.S.; Neuroendovascular Program (A.A.D.), Massachusetts General Hospital, Boston, Massachusetts, U.S.; Department of Diagnostic and Interventional Neuroradiology (A.G.), Erasme University Hospital, Brussels, Belgium; Department of Neurology (G.W.A., J.J.H.), Stanford University, Stanford, California, U.S.; Department of Radiology (T.D.F.), Neuroendovascular Program, University Medical Center Münster, Munster, Germany.
Rafael H. Llinas
From the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., V.S.Y.), Johns Hopkins University, Baltimore, Maryland, U.S.; Department of Medicine (A.N.), Allama Iqbal Medical College, Lahore, Punjab, Pakistan; Mass General Brigham (A.B.U.K.), Massachusetts, U.S.; Division of Interventional Radiology, Department of Radiology (A.H.), Northwestern Memorial Hospital, Chicago, Illinois, U.S.; Dow University of Health Sciences (S.W.), Karachi, Pakistan; HMH JFK University Medical Center (S.K.), Edison, New Jersey, U.S.; University of Toledo (S.M.O.), Toledo, Ohio, U.S.; Shadan Institute of Medical Sciences (N.B.), Hyderabad, Telangana, India; Stony Brook University Renaissance School of Medicine (V.S.V), New York, U.S.; University of Cincinnati College of Medicine (Y.N.A.), Cincinnati, Ohio, U.S.; Department of Neurology (R.L.), Johns Hopkins Medicine, Baltimore, Maryland, U.S.; Neuroendovascular Program (A.A.D.), Massachusetts General Hospital, Boston, Massachusetts, U.S.; Department of Diagnostic and Interventional Neuroradiology (A.G.), Erasme University Hospital, Brussels, Belgium; Department of Neurology (G.W.A., J.J.H.), Stanford University, Stanford, California, U.S.; Department of Radiology (T.D.F.), Neuroendovascular Program, University Medical Center Münster, Munster, Germany.
Elisabeth B. Marsh
From the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., V.S.Y.), Johns Hopkins University, Baltimore, Maryland, U.S.; Department of Medicine (A.N.), Allama Iqbal Medical College, Lahore, Punjab, Pakistan; Mass General Brigham (A.B.U.K.), Massachusetts, U.S.; Division of Interventional Radiology, Department of Radiology (A.H.), Northwestern Memorial Hospital, Chicago, Illinois, U.S.; Dow University of Health Sciences (S.W.), Karachi, Pakistan; HMH JFK University Medical Center (S.K.), Edison, New Jersey, U.S.; University of Toledo (S.M.O.), Toledo, Ohio, U.S.; Shadan Institute of Medical Sciences (N.B.), Hyderabad, Telangana, India; Stony Brook University Renaissance School of Medicine (V.S.V), New York, U.S.; University of Cincinnati College of Medicine (Y.N.A.), Cincinnati, Ohio, U.S.; Department of Neurology (R.L.), Johns Hopkins Medicine, Baltimore, Maryland, U.S.; Neuroendovascular Program (A.A.D.), Massachusetts General Hospital, Boston, Massachusetts, U.S.; Department of Diagnostic and Interventional Neuroradiology (A.G.), Erasme University Hospital, Brussels, Belgium; Department of Neurology (G.W.A., J.J.H.), Stanford University, Stanford, California, U.S.; Department of Radiology (T.D.F.), Neuroendovascular Program, University Medical Center Münster, Munster, Germany.
Richard Leigh
From the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., V.S.Y.), Johns Hopkins University, Baltimore, Maryland, U.S.; Department of Medicine (A.N.), Allama Iqbal Medical College, Lahore, Punjab, Pakistan; Mass General Brigham (A.B.U.K.), Massachusetts, U.S.; Division of Interventional Radiology, Department of Radiology (A.H.), Northwestern Memorial Hospital, Chicago, Illinois, U.S.; Dow University of Health Sciences (S.W.), Karachi, Pakistan; HMH JFK University Medical Center (S.K.), Edison, New Jersey, U.S.; University of Toledo (S.M.O.), Toledo, Ohio, U.S.; Shadan Institute of Medical Sciences (N.B.), Hyderabad, Telangana, India; Stony Brook University Renaissance School of Medicine (V.S.V), New York, U.S.; University of Cincinnati College of Medicine (Y.N.A.), Cincinnati, Ohio, U.S.; Department of Neurology (R.L.), Johns Hopkins Medicine, Baltimore, Maryland, U.S.; Neuroendovascular Program (A.A.D.), Massachusetts General Hospital, Boston, Massachusetts, U.S.; Department of Diagnostic and Interventional Neuroradiology (A.G.), Erasme University Hospital, Brussels, Belgium; Department of Neurology (G.W.A., J.J.H.), Stanford University, Stanford, California, U.S.; Department of Radiology (T.D.F.), Neuroendovascular Program, University Medical Center Münster, Munster, Germany.
Hanzhang Lu
From the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., V.S.Y.), Johns Hopkins University, Baltimore, Maryland, U.S.; Department of Medicine (A.N.), Allama Iqbal Medical College, Lahore, Punjab, Pakistan; Mass General Brigham (A.B.U.K.), Massachusetts, U.S.; Division of Interventional Radiology, Department of Radiology (A.H.), Northwestern Memorial Hospital, Chicago, Illinois, U.S.; Dow University of Health Sciences (S.W.), Karachi, Pakistan; HMH JFK University Medical Center (S.K.), Edison, New Jersey, U.S.; University of Toledo (S.M.O.), Toledo, Ohio, U.S.; Shadan Institute of Medical Sciences (N.B.), Hyderabad, Telangana, India; Stony Brook University Renaissance School of Medicine (V.S.V), New York, U.S.; University of Cincinnati College of Medicine (Y.N.A.), Cincinnati, Ohio, U.S.; Department of Neurology (R.L.), Johns Hopkins Medicine, Baltimore, Maryland, U.S.; Neuroendovascular Program (A.A.D.), Massachusetts General Hospital, Boston, Massachusetts, U.S.; Department of Diagnostic and Interventional Neuroradiology (A.G.), Erasme University Hospital, Brussels, Belgium; Department of Neurology (G.W.A., J.J.H.), Stanford University, Stanford, California, U.S.; Department of Radiology (T.D.F.), Neuroendovascular Program, University Medical Center Münster, Munster, Germany.
Adam A. Dmytriw
From the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., V.S.Y.), Johns Hopkins University, Baltimore, Maryland, U.S.; Department of Medicine (A.N.), Allama Iqbal Medical College, Lahore, Punjab, Pakistan; Mass General Brigham (A.B.U.K.), Massachusetts, U.S.; Division of Interventional Radiology, Department of Radiology (A.H.), Northwestern Memorial Hospital, Chicago, Illinois, U.S.; Dow University of Health Sciences (S.W.), Karachi, Pakistan; HMH JFK University Medical Center (S.K.), Edison, New Jersey, U.S.; University of Toledo (S.M.O.), Toledo, Ohio, U.S.; Shadan Institute of Medical Sciences (N.B.), Hyderabad, Telangana, India; Stony Brook University Renaissance School of Medicine (V.S.V), New York, U.S.; University of Cincinnati College of Medicine (Y.N.A.), Cincinnati, Ohio, U.S.; Department of Neurology (R.L.), Johns Hopkins Medicine, Baltimore, Maryland, U.S.; Neuroendovascular Program (A.A.D.), Massachusetts General Hospital, Boston, Massachusetts, U.S.; Department of Diagnostic and Interventional Neuroradiology (A.G.), Erasme University Hospital, Brussels, Belgium; Department of Neurology (G.W.A., J.J.H.), Stanford University, Stanford, California, U.S.; Department of Radiology (T.D.F.), Neuroendovascular Program, University Medical Center Münster, Munster, Germany.
Adrien Guenego
From the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., V.S.Y.), Johns Hopkins University, Baltimore, Maryland, U.S.; Department of Medicine (A.N.), Allama Iqbal Medical College, Lahore, Punjab, Pakistan; Mass General Brigham (A.B.U.K.), Massachusetts, U.S.; Division of Interventional Radiology, Department of Radiology (A.H.), Northwestern Memorial Hospital, Chicago, Illinois, U.S.; Dow University of Health Sciences (S.W.), Karachi, Pakistan; HMH JFK University Medical Center (S.K.), Edison, New Jersey, U.S.; University of Toledo (S.M.O.), Toledo, Ohio, U.S.; Shadan Institute of Medical Sciences (N.B.), Hyderabad, Telangana, India; Stony Brook University Renaissance School of Medicine (V.S.V), New York, U.S.; University of Cincinnati College of Medicine (Y.N.A.), Cincinnati, Ohio, U.S.; Department of Neurology (R.L.), Johns Hopkins Medicine, Baltimore, Maryland, U.S.; Neuroendovascular Program (A.A.D.), Massachusetts General Hospital, Boston, Massachusetts, U.S.; Department of Diagnostic and Interventional Neuroradiology (A.G.), Erasme University Hospital, Brussels, Belgium; Department of Neurology (G.W.A., J.J.H.), Stanford University, Stanford, California, U.S.; Department of Radiology (T.D.F.), Neuroendovascular Program, University Medical Center Münster, Munster, Germany.
Gregory W. Albers
From the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., V.S.Y.), Johns Hopkins University, Baltimore, Maryland, U.S.; Department of Medicine (A.N.), Allama Iqbal Medical College, Lahore, Punjab, Pakistan; Mass General Brigham (A.B.U.K.), Massachusetts, U.S.; Division of Interventional Radiology, Department of Radiology (A.H.), Northwestern Memorial Hospital, Chicago, Illinois, U.S.; Dow University of Health Sciences (S.W.), Karachi, Pakistan; HMH JFK University Medical Center (S.K.), Edison, New Jersey, U.S.; University of Toledo (S.M.O.), Toledo, Ohio, U.S.; Shadan Institute of Medical Sciences (N.B.), Hyderabad, Telangana, India; Stony Brook University Renaissance School of Medicine (V.S.V), New York, U.S.; University of Cincinnati College of Medicine (Y.N.A.), Cincinnati, Ohio, U.S.; Department of Neurology (R.L.), Johns Hopkins Medicine, Baltimore, Maryland, U.S.; Neuroendovascular Program (A.A.D.), Massachusetts General Hospital, Boston, Massachusetts, U.S.; Department of Diagnostic and Interventional Neuroradiology (A.G.), Erasme University Hospital, Brussels, Belgium; Department of Neurology (G.W.A., J.J.H.), Stanford University, Stanford, California, U.S.; Department of Radiology (T.D.F.), Neuroendovascular Program, University Medical Center Münster, Munster, Germany.
Jeremy J. Heit
From the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., V.S.Y.), Johns Hopkins University, Baltimore, Maryland, U.S.; Department of Medicine (A.N.), Allama Iqbal Medical College, Lahore, Punjab, Pakistan; Mass General Brigham (A.B.U.K.), Massachusetts, U.S.; Division of Interventional Radiology, Department of Radiology (A.H.), Northwestern Memorial Hospital, Chicago, Illinois, U.S.; Dow University of Health Sciences (S.W.), Karachi, Pakistan; HMH JFK University Medical Center (S.K.), Edison, New Jersey, U.S.; University of Toledo (S.M.O.), Toledo, Ohio, U.S.; Shadan Institute of Medical Sciences (N.B.), Hyderabad, Telangana, India; Stony Brook University Renaissance School of Medicine (V.S.V), New York, U.S.; University of Cincinnati College of Medicine (Y.N.A.), Cincinnati, Ohio, U.S.; Department of Neurology (R.L.), Johns Hopkins Medicine, Baltimore, Maryland, U.S.; Neuroendovascular Program (A.A.D.), Massachusetts General Hospital, Boston, Massachusetts, U.S.; Department of Diagnostic and Interventional Neuroradiology (A.G.), Erasme University Hospital, Brussels, Belgium; Department of Neurology (G.W.A., J.J.H.), Stanford University, Stanford, California, U.S.; Department of Radiology (T.D.F.), Neuroendovascular Program, University Medical Center Münster, Munster, Germany.
Tobias D. Faizy
From the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., V.S.Y.), Johns Hopkins University, Baltimore, Maryland, U.S.; Department of Medicine (A.N.), Allama Iqbal Medical College, Lahore, Punjab, Pakistan; Mass General Brigham (A.B.U.K.), Massachusetts, U.S.; Division of Interventional Radiology, Department of Radiology (A.H.), Northwestern Memorial Hospital, Chicago, Illinois, U.S.; Dow University of Health Sciences (S.W.), Karachi, Pakistan; HMH JFK University Medical Center (S.K.), Edison, New Jersey, U.S.; University of Toledo (S.M.O.), Toledo, Ohio, U.S.; Shadan Institute of Medical Sciences (N.B.), Hyderabad, Telangana, India; Stony Brook University Renaissance School of Medicine (V.S.V), New York, U.S.; University of Cincinnati College of Medicine (Y.N.A.), Cincinnati, Ohio, U.S.; Department of Neurology (R.L.), Johns Hopkins Medicine, Baltimore, Maryland, U.S.; Neuroendovascular Program (A.A.D.), Massachusetts General Hospital, Boston, Massachusetts, U.S.; Department of Diagnostic and Interventional Neuroradiology (A.G.), Erasme University Hospital, Brussels, Belgium; Department of Neurology (G.W.A., J.J.H.), Stanford University, Stanford, California, U.S.; Department of Radiology (T.D.F.), Neuroendovascular Program, University Medical Center Münster, Munster, Germany.
Vivek S. Yedavalli
From the Department of Radiology and Radiological Sciences (S.R., D.A.L., H.A.S., R.X., A.E.H., V.C.U., R.H.L., E.B.M., H.L., V.S.Y.), Johns Hopkins University, Baltimore, Maryland, U.S.; Department of Medicine (A.N.), Allama Iqbal Medical College, Lahore, Punjab, Pakistan; Mass General Brigham (A.B.U.K.), Massachusetts, U.S.; Division of Interventional Radiology, Department of Radiology (A.H.), Northwestern Memorial Hospital, Chicago, Illinois, U.S.; Dow University of Health Sciences (S.W.), Karachi, Pakistan; HMH JFK University Medical Center (S.K.), Edison, New Jersey, U.S.; University of Toledo (S.M.O.), Toledo, Ohio, U.S.; Shadan Institute of Medical Sciences (N.B.), Hyderabad, Telangana, India; Stony Brook University Renaissance School of Medicine (V.S.V), New York, U.S.; University of Cincinnati College of Medicine (Y.N.A.), Cincinnati, Ohio, U.S.; Department of Neurology (R.L.), Johns Hopkins Medicine, Baltimore, Maryland, U.S.; Neuroendovascular Program (A.A.D.), Massachusetts General Hospital, Boston, Massachusetts, U.S.; Department of Diagnostic and Interventional Neuroradiology (A.G.), Erasme University Hospital, Brussels, Belgium; Department of Neurology (G.W.A., J.J.H.), Stanford University, Stanford, California, U.S.; Department of Radiology (T.D.F.), Neuroendovascular Program, University Medical Center Münster, Munster, Germany.
ABSTRACT
The hypoperfusion intensity ratio (HIR) is a quantitative metric used in vascular occlusion imaging to evaluate the extent of brain tissue at risk due to hypoperfusion. Defined as the ratio of tissue volume with a time-to-maximum (Tmax) of >10 seconds to that of >6 seconds, HIR assists in differentiating between the salvageable penumbra and the irreversibly injured core infarct. This review explores the role of HIR in assessing clinical outcomes and guiding treatment strategies, including mechanical thrombectomy and thrombolytic therapy, for patients with large vessel occlusions (LVOs). Evidence suggests that higher HIR values are associated with worse clinical outcomes, indicating more severe tissue damage and reduced potential for salvage through reperfusion. Additionally, HIR demonstrates predictive accuracy regarding infarct growth, collateral flow, and the risk of reperfusion hemorrhage. It has shown superiority over traditional metrics, such as core infarct volume, in predicting functional outcomes. HIR offers valuable insights for risk stratification and treatment planning in patients with LVOs and distal medium vessel occlusions (DMVOs). Incorporating HIR into clinical practice enhances patient care by improving decision-making processes, promoting timely interventions, and optimizing post-intervention management to minimize complications and improve recovery outcomes.
Footnotes
The authors declare no conflicts of interest related to the content of this article.
- © 2024 by American Journal of Neuroradiology
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Accepted Manuscript
Sana Rehman, Arsalan Nadeem, Arbab Burhan Uddin Kasi, Ali Husnain, Summaiyya Waseem, Sohail Kumar, Syed Muhammad Owais, Nasreen Banu, Dhairya A. Lakhani, Hamza A. Salim, Risheng Xu, Vaibhav S. Vagal, Yasmin N. Aziz, Argye E. Hillis, Victor C. Urrutia, Rafael H. Llinas, Elisabeth B. Marsh, Richard Leigh, Hanzhang Lu, Adam A. Dmytriw, Adrien Guenego, Gregory W. Albers, Jeremy J. Heit, Tobias D. Faizy, Vivek S. Yedavalli
Role of Hypoperfusion Intensity Ratio in Vessel Occlusions: A Review on Safety and Clinical Outcomes
American Journal of Neuroradiology Oct 2024, ajnr.A8557; DOI: 10.3174/ajnr.A8557
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Accepted Manuscript
Role of Hypoperfusion Intensity Ratio in Vessel Occlusions: A Review on Safety and Clinical Outcomes
Sana Rehman, Arsalan Nadeem, Arbab Burhan Uddin Kasi, Ali Husnain, Summaiyya Waseem, Sohail Kumar, Syed Muhammad Owais, Nasreen Banu, Dhairya A. Lakhani, Hamza A. Salim, Risheng Xu, Vaibhav S. Vagal, Yasmin N. Aziz, Argye E. Hillis, Victor C. Urrutia, Rafael H. Llinas, Elisabeth B. Marsh, Richard Leigh, Hanzhang Lu, Adam A. Dmytriw, Adrien Guenego, Gregory W. Albers, Jeremy J. Heit, Tobias D. Faizy, Vivek S. Yedavalli
American Journal of Neuroradiology Oct 2024, ajnr.A8557; DOI: 10.3174/ajnr.A8557
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