Perfusion imaging threshold of delay time >4 seconds defines no-reflow and predicts 90-day outcome after stroke thrombectomy

In acute stroke after successful thrombectomy, a no-reflow lesion with delay time >4 s on 24-hour perfusion imaging strongly predicted poor 90-day functional outcome (OR 12.14, 95% CI 3.38–54.63).

• The best no-reflow definition was a residual hypoperfusion lesion with delay time >4 seconds, present in 21% (14/67) of patients with excellent recanalization.
• Poor functional outcome occurred in 79% of no-reflow vs 21% of reflow patients; infarct growth was greater with no-reflow (median 24.1 mL vs 0 mL, p<.001).
• Findings were replicated in an independent validation cohort of 54 patients.

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