Prognostic Value of the Cerebral Blood Volume Index After Successful Recanalization in Acute Ischemic Stroke with Large Vessel Occlusion.

RATIONALE AND OBJECTIVES: Patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO) remain at risk of hemorrhagic transformation (HT) and poor functional outcomes despite successful reperfusion after endovascular therapy (EVT). We assessed the association of the cerebral blood volume (CBV) index with HT and 90-day functional outcomes in patients who achieved successful recanalization. METHODS: This retrospective study included AIS-LVO patients who underwent EVT from November 2020 to June 2024. The CBV index was calculated as the ratio of the average CBV within the delayed perfusion region (defined as Tmax > 6 s) to that in the contralateral non-ischemic brain tissue (defined as Tmax ≤4 s). The primary outcome was 90-day functional independence (mRS 0-2), and the secondary outcome was HT incidence, assessed by follow-up CT at 24 h. RESULTS: Among 334 patients, multivariable regression showed the CBV index was associated with favorable 90-day outcomes (mRS 0-2) (OR=0.710 [95% CI,0.584-0.862], P<0.001) and excellent outcomes (mRS 0-1) (OR=0.759, [95% CI,0.616-0.936], P=0.010). Adding the CBV index to conventional risk factors increased the area under the receiver operating characteristic curve from 0.764 (95% CI, 0.711-0.816) to 0.814 (95% CI, 0.767-0.860; P=0.001). The CBV index was also an independent predictor of HT (OR=0.822 [95% CI, 0.690-0.980], P=0.029), parenchymal hematoma (OR=0.807 [95% CI, 0.660-0.986], P=0.036), and symptomatic intracranial hemorrhage (OR=0.734 [95% CI, 0.579-0.931], P=0.011) post-EVT. CONCLUSION: The CBV index was independently associated with HT and 90-day functional outcomes following successful EVT and may provide incremental prognostic value beyond conventional risk factors.