{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T19:06:16Z","timestamp":1790622376761,"version":"4.1.0"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>The optimal management of isolated posterior cerebral artery occlusion (iPCAO) remains unclear. We investigated whether baseline perfusion imaging parameters are associated with clinical outcomes and whether they modify the association between endovascular therapy (EVT) and outcomes in iPCAO.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>This prespecified secondary analysis of the international, multicenter, observational PLATO (Posterior Cerebral Artery Occlusion) registry (35 centers, 10 countries, 2015\u20132025) included consecutive adults with unilateral iPCAO and baseline perfusion imaging (computed tomography or magnetic resonance imaging) with reconstructed parameters. The primary end point was an excellent 90-day outcome (modified Rankin Scale score, 0\u20131). Perfusion parameters included hypoperfusion volume, infarct core volume, and mismatch ratio. The primary analysis used multivariable mixed-effects regression models (center as random effect) to assess associations between perfusion parameters and outcomes, adjusting for age, sex, treatment year, prestroke modified Rankin Scale score, baseline National Institutes of Health Stroke Scale score, diabetes, stroke cause, posterior circulation Acute Stroke Prognosis Early Computed Tomography Score, occlusion site, intravenous thrombolysis, and onset-to-door time. To test whether the association between EVT and outcomes varies according to baseline perfusion parameters, we evaluated treatment-by-perfusion interactions by including interaction terms (treatment\u00d7perfusion parameter) in inverse probability of treatment weighting\u2013adjusted models, with results expressed as ratios of odds ratios (ORs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Of 1811 patients with iPCAO, 443 met inclusion criteria (median age, 74 years; 41.8% female). Larger hypoperfusion volume was associated with lower odds of excellent outcome (adjusted OR, 0.72 [95% CI, 0.58\u20130.89] per 1-unit increase in natural logarithm\u2013transformed volume). No interaction between perfusion parameters and EVT was observed for the primary outcome. However, increasing core volume was associated with a progressively less favorable modified Rankin Scale score shift (ratio of OR, 0.66 [95% CI, 0.48\u20130.90];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      <jats:sub>interaction<\/jats:sub>\n                      =0.009) and higher mortality (ratio of OR, 1.82 [95% CI, 1.10\u20133.03];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      <jats:sub>interaction<\/jats:sub>\n                      =0.021) with EVT compared with medical management. Increasing hypoperfusion volume was associated with a higher risk of symptomatic intracranial hemorrhage with EVT (ratio of OR, 10.15 [95% CI, 1.06\u201396.93];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      <jats:sub>interaction<\/jats:sub>\n                      =0.044).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>In iPCAO, perfusion imaging provides independent prognostic information but does not identify patients with potential benefit from EVT and may instead indicate those at higher procedural risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/osf.io\/62mwt\">https:\/\/osf.io\/62mwt<\/jats:ext-link>\n                      ; Unique identifier: NCT05291637.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.126.055949","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T09:00:13Z","timestamp":1783587613000},"page":"2661-2676","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Role of Perfusion Parameters on Outcomes and Safety of Endovascular Therapy in Posterior Cerebral Artery Stroke"],"prefix":"10.1161","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-7801-7722","authenticated-orcid":true,"given":"Norma J.","family":"Diel","sequence":"first","affiliation":[{"name":"Department of Neurology (N.J.D., V.P.), Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universit\u00e4t Dresden, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4429-2714","authenticated-orcid":true,"given":"Davide","family":"Strambo","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Service of Neurology (D. Strambo, P.M.), Lausanne University Hospital and University of Lausanne, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9528-301X","authenticated-orcid":true,"given":"Mohamad","family":"Abdalkader","sequence":"additional","affiliation":[{"name":"Department of Radiology (M.A., M.M.Q., P.K., B.D., T.N.N.), Boston Medical Center, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2056-3308","authenticated-orcid":true,"given":"Muhammad M.","family":"Qureshi","sequence":"additional","affiliation":[{"name":"Department of Radiology (M.A., M.M.Q., P.K., B.D., T.N.N.), Boston Medical Center, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9897-4561","authenticated-orcid":true,"given":"Vincent","family":"Dunet","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology (V.D., B.B., S. Pistocchi), Lausanne University Hospital and University of Lausanne, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6055-0221","authenticated-orcid":true,"given":"Bruno","family":"Bartolini","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology (V.D., B.B., S. Pistocchi), Lausanne University Hospital and University of Lausanne, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5427-4299","authenticated-orcid":true,"given":"Silvia","family":"Pistocchi","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology (V.D., B.B., S. Pistocchi), Lausanne University Hospital and University of Lausanne, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9095-2344","authenticated-orcid":true,"given":"Daniel","family":"Strbian","sequence":"additional","affiliation":[{"name":"Department of Neurology (D. Strbian, S.R.), Helsinki University Hospital and University of Helsinki, Finland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6921-0597","authenticated-orcid":true,"given":"Silja","family":"R\u00e4ty","sequence":"additional","affiliation":[{"name":"Department of Neurology (D. Strbian, S.R.), Helsinki University Hospital and University of Helsinki, Finland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9223-9662","authenticated-orcid":true,"given":"Christian","family":"Herweh","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology (C.H., M. M\u00f6hlenbruch), Heidelberg University Hospital, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5075-704X","authenticated-orcid":true,"given":"Markus","family":"M\u00f6hlenbruch","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology (C.H., M. M\u00f6hlenbruch), Heidelberg University Hospital, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4637-1598","authenticated-orcid":true,"given":"Marta","family":"Oliv\u00e9-Gadea","sequence":"additional","affiliation":[{"name":"Department of Neurology (M.O.-G., M. Ribo, M. Requena, T.J.-B.), University Hospital Basel, University of Basel, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9242-043X","authenticated-orcid":true,"given":"Marc","family":"Ribo","sequence":"additional","affiliation":[{"name":"Department of Neurology (M.O.-G., M. Ribo, M. Requena, T.J.-B.), University Hospital Basel, University of Basel, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0016-414X","authenticated-orcid":true,"given":"Marios","family":"Psychogios","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology (M.P., U.F., A.N.), University Hospital Basel, University of Basel, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0521-4051","authenticated-orcid":true,"given":"Urs","family":"Fischer","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology (M.P., U.F., A.N.), University Hospital Basel, University of Basel, Switzerland."},{"name":"Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9343-8276","authenticated-orcid":true,"given":"Anh","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology (M.P., U.F., A.N.), University Hospital Basel, University of Basel, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7630-7880","authenticated-orcid":true,"given":"Joji B.","family":"Kuramatsu","sequence":"additional","affiliation":[{"name":"Department of Neurology (J.B.K., D.H.), University of Erlangen, Germany."},{"name":"Department of Neurology, RoMed Klinikum Rosenheim, Germany (J.B.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4598-7120","authenticated-orcid":true,"given":"David","family":"Haupenthal","sequence":"additional","affiliation":[{"name":"Department of Neurology (J.B.K., D.H.), University of Erlangen, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0701-9535","authenticated-orcid":true,"given":"Martin","family":"K\u00f6hrmann","sequence":"additional","affiliation":[{"name":"Department of Neurology, Universit\u00e4tsklinikum Essen, Germany (M.K., J.K.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9262-7289","authenticated-orcid":true,"given":"Cornelius","family":"Deuschl","sequence":"additional","affiliation":[{"name":"Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany (C.D.)."},{"name":"Institute for Diagnostic and Interventional Radiology, Neuroradiology and Nuclear Medicine, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Germany (C.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8742-0694","authenticated-orcid":true,"given":"Jordi","family":"K\u00fchne Escol\u00e0","sequence":"additional","affiliation":[{"name":"Department of Neurology, Universit\u00e4tsklinikum Essen, Germany (M.K., J.K.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8186-0237","authenticated-orcid":true,"given":"Jelle","family":"Demeestere","sequence":"additional","affiliation":[{"name":"Department of Neurology, UZ Leuven, Belgium (J.D., R. 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Farzad","family":"Maroufi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery (S.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1415-3027","authenticated-orcid":true,"given":"Volker","family":"Puetz","sequence":"additional","affiliation":[{"name":"Department of Neurology (N.J.D., V.P.), Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universit\u00e4t Dresden, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5258-0025","authenticated-orcid":true,"given":"Daniel P.O.","family":"Kaiser","sequence":"additional","affiliation":[{"name":"Institute of Neuroradiology (D.P.O.K.), Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universit\u00e4t Dresden, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9177-2289","authenticated-orcid":true,"given":"Johannes","family":"Kaesmacher","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Neuroradiology (J.K., A. 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Mujanovic, B.L.S.), University Hospital Bern, University of Bern, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7635-6535","authenticated-orcid":true,"given":"Dominique Cornelius","family":"Marterstock","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology (D.C.M., T.E.), University of Erlangen, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7341-3584","authenticated-orcid":true,"given":"Tobias","family":"Engelhorn","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology (D.C.M., T.E.), University of Erlangen, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5671-6484","authenticated-orcid":true,"given":"Manuel","family":"Requena","sequence":"additional","affiliation":[{"name":"Department of Neurology (M.O.-G., M. Ribo, M. 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