Tmax volume can predict clinical type in patients with acute ischemic stroke

Objective Endovascular therapy (EVT) is performed for acute ischemic stroke (AIS) with large vessel occlusion (LVO), however, the treatment strategies and clinical outcomes differ between cardiac embolism (CE) and intracranial arteriosclerosis‐derived LVO (ICAS‐LVO). We analyzed whether the time‐to‐max (Tmax) volume derived from perfusion imaging predicted clinical classification in AIS patients before EVT. Methods Consecutive AIS patients with anterior circulation LVO evaluated by automated imaging software were retrospectively identified. Patients were classified into a CE group and an ICAS‐LVO group, and parameters were compared between groups. Results Thirty‐nine patients were included and Tmax volume and Tmax > 6 s volume/Tmax > 4 s volume were significantly greater in the CE group than in the ICAS‐LVO group (Tmax > 4 s volume: 261 mL vs. 149 mL, p = .01, Tmax > 6 s volume: 143 mL vs. 59 mL, p = .001, Tmax > 6 s volume/Tmax > 4 s volume: 0.59 vs. 0.40, p 6 s volume/Tmax > 4 s volume (p = .04). Conclusion The Tmax volume derived from perfusion imaging predicts the clinical classification of AIS patients before EVT. Acute ischemic stroke (AIS) due to large vessel occlusion (LVO) is indicated for endovascular treatment (EVT), but treatment strategies and clinical outcomes differ depending on clinical type between cardiac embolism‐induced cerebral LVO and intracranial atherosclerosis‐related LVO. The present study showed that Tmax volumes and Tmax > 6 s volume/Tmax > 4 s volume obtained from perfusion imaging can predict the clinical type in patients with AIS prior to EVT.