To explore the prognostic value of the hypoperfusion intensity ratio (HIR) on 90-day clinical outcome after mechanical thrombectomy (MT) for acute ischemic stroke with large vessel occlusion (AIS-LVO) in elderly (≥80 years) patients.

We retrospectively analyzed the clinical data and imaging materials of the patients with large vessel occlusion, who received mechanical thrombectomy at the First Affiliated Hospital of Nanjing Medical University of China between January 2020 and January 2023. The HIR was defined as the T_max (time to maximum ) > 10 s lesion volume divided by the T_max > 6 s lesion volume. According to the modified Rankin scale (mRS) score 90 d after operation, the patients were divided into favorable prognosis (mRS score ≤2) group and poor prognosis (mRS score 3~6) group. The clinical and imaging data of the 2 groups were compared. The influencing factors of the prognosis 90 d after operation were determined by multivariate logistic regression analysis.

A total of 93 patients were enrolled in this study, including 22 cases in the good prognosis group and 71 cases in the poor prognosis group. Compared with the patients in the poor prognosis group, the patients in the good prognosis group had a smaller core infarction volume, lower HIR and lower baseline National Institute of Health stroke scale ( NIHSS ) score with significant differences (all P < 0.05). Multivariate Logistic regression analysis showed that HIR (OR = 1.424, 95%CI: 1.022~1.984; P = 0.037), collateral scoring (OR = 0.491, 95%CI: 0.263~0.91; P = 0.025) and baseline NIHSS (OR = 1.221, 95%CI: 1.077~1.385; P = 0.002) were independent predictors for prognosis of patients with anterior circulation AIS-LVO 90 d after MT aged ≥80 years.

Low HIR was a predictor for favorable outcome in AIS patients aged ≥80 years.