{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T13:45:53Z","timestamp":1790948753459,"version":"4.1.0"},"reference-count":43,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Recent large core trials have highlighted the effectiveness of mechanical thrombectomy (MT) in acute ischemic stroke with large vessel occlusion. Variable perfusion-imaging thresholds and poor Alberta Stroke Program Early Computed Tomography Score reliability underline the need for more standardized, quantitative ischemia measures for MT patient selection. We aimed to identify the computed tomography perfusion parameter most strongly associated with poor outcomes in patients with acute ischemic stroke-large vessel occlusion with significant ischemic cores.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>In this study from 2 comprehensive stroke centers from 2 comprehensive stroke centers within the Johns Hopkins Medical Enterprise (Johns Hopkins Hospita\u2014East Baltimore and Bayview Medical Campus) from July 29, 2019 to January 29, 2023 in a continuously maintained database, we included patients with acute ischemic stroke-large vessel occlusion with ischemic core volumes defined as relative cerebral blood flow &lt;30% and \u226550 mL on computed tomography perfusion or Alberta Stroke Program Early Computed Tomography Score &lt;6. We used receiver operating characteristics to find the optimal cutoff for parameters like cerebral blood volume (CBV) &lt;34%, 38%, 42%, and relative cerebral blood flow &gt;20%, 30%, 34%, 38%, and time-to-maximum &gt;4, 6, 8, and 10 seconds. The primary outcome was unfavorable outcomes (90-day modified Rankin Scale score 4\u20136). Multivariable models were adjusted for age, sex, diabetes, baseline National Institutes of Health Stroke Scale, intravenous thrombolysis, and MT.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>We identified 59 patients with large ischemic cores. A receiver operating characteristic curve analysis showed that CBV&lt;42% \u226568 mL is associated with unfavorable outcomes (90-day modified Rankin Scale score 4\u20136) with an area under the curve of 0.90 (95% CI, 0.82\u20130.99) in the total and MT-only cohorts. Dichotomizing at this CBV threshold, patients in the \u226568 mL group exhibited significantly higher relative cerebral blood flow, time-to-maximum &gt;8 and 10 seconds volumes, higher CBV volumes, higher HIR, and lower CBV index. The multivariable model incorporating CBV&lt;42% \u226568 mL predicted poor outcomes robustly in both cohorts (area under the curve for MT-only subgroup was 0.87 [95% CI, 0.75\u20131.00]).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>CBV&lt;42% \u226568 mL most effectively forecasts poor outcomes in patients with large-core stroke, confirming its value alongside other parameters like time-to-maximum in managing acute ischemic stroke-large vessel occlusion.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.124.047483","type":"journal-article","created":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T09:00:27Z","timestamp":1724662827000},"page":"2409-2419","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":37,"title":["Decreased Quantitative Cerebral Blood Volume Is Associated With Poor Outcomes in Large Core Patients"],"prefix":"10.1161","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2450-4014","authenticated-orcid":true,"given":"Vivek","family":"Yedavalli","sequence":"first","affiliation":[{"name":"Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5208-8425","authenticated-orcid":true,"given":"Hamza Adel","family":"Salim","sequence":"additional","affiliation":[{"name":"Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"Mei","sequence":"additional","affiliation":[{"name":"Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7577-1887","authenticated-orcid":true,"given":"Dhairya A.","family":"Lakhani","sequence":"additional","affiliation":[{"name":"Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.)."},{"name":"Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston (D.A.L., A.A.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3592-708X","authenticated-orcid":true,"given":"Aneri","family":"Balar","sequence":"additional","affiliation":[{"name":"Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4910-6090","authenticated-orcid":true,"given":"Basel","family":"Musmar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University (B.M., N.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8668-7629","authenticated-orcid":true,"given":"Nimer","family":"Adeeb","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University (B.M., N.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4051-2946","authenticated-orcid":true,"given":"Meisam","family":"Hoseinyazdi","sequence":"additional","affiliation":[{"name":"Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3539-4831","authenticated-orcid":true,"given":"Licia","family":"Luna","sequence":"additional","affiliation":[{"name":"Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3117-5076","authenticated-orcid":true,"given":"Francis","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2758-3402","authenticated-orcid":true,"given":"Nathan Z.","family":"Hyson","sequence":"additional","affiliation":[{"name":"Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD (V.Y., H.A.S., J.M., D.A.L., A.B., M.H., L.L., F.D., N.Z.H., H.L., V.C.U., E.B.M., A.E.H., R.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0131-5699","authenticated-orcid":true,"given":"Adam A.","family":"Dmytriw","sequence":"additional","affiliation":[{"name":"Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston (D.A.L., A.A.D.)."},{"name":"Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael\u2019s Hospital, Toronto, ON, Canada 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