Perfusion Collateral Impairment Score Adds Incremental Prognostic Value in LVO Stroke — But Only as an Adjunct

In 283 anterior circulation LVO stroke patients, adding the Perfusion Collateral Impairment Score (PCIS) to standard collateral scores improved 90-day poor-outcome prediction (COVES+PCIS aOR 1.53, 95% CI 1.17–2.01), but PCIS alone did not outperform comparators after correction.

• Retrospective study of 283 anterior circulation LVO patients; 52.3% had unfavorable 90-day outcomes (mRS 3–6); PCIS was tested against Tan, COVES, ASPECTS, rCBF <30% volume, and mismatch volume using paired DeLong testing with Bonferroni correction.
• Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were significant for all 5 imaging pairs (all P ≤ 0.014), supporting incremental value; however, after age + NIHSS adjustment, only the COVES+PCIS model retained independent significance (aOR 1.37, 95% CI 1.02–1.85, P = 0.039).
• Key limitation: standalone PCIS AUC did not exceed any comparator after Bonferroni correction, indicating modest individual discrimination; generalizability requires prospective, multicenter validation before clinical adoption.

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