Among symptomatic nonacute intracranial atherosclerotic occlusion (ICAO), endovascular recanalization has shown potential efficacy and acceptable periprocedural complications. However, the long-term benefits of stent implantation could be diminished by in-stent restenosis (ISR). This study aimed to investigate the association between radiological features on preoperative high-resolution MRI (HR-MRI) and ISR. We retrospectively reviewed 103 patients with symptomatic nonacute ICAO who underwent stenting between January 2018 to December 2024 at our institution. Patients’ clinical-hematological parameters, HR-MRI features and procedural results were collected. Potential factors related to ISR were analyzed by univariate and multivariate analyses. At a median 4.1-month imaging follow-up, this study observed a ISR rate of 29.1

BACKGROUND AND PURPOSE:For symptomatic nonacute long-segment internal carotid artery occlusion (LICAO) lesions, the endovascular treatment strategies are always complex and challenging. This study aims to analyze the effect of 2 recanalization techniques (angioplasty without distal embolic protection [AWDEP] or direct Aspiration Recanalization Combined with AngioplaSty under Intracranial Stent retriever protection [ARSIS]) on the technical success rate and clinical prognosis. MATERIALS AND METHODS:Fifty-three patients with LICAO who underwent endovascular treatment at our center were retrospectively analyzed, including 41 (77.4%) patients in the AWDEP group and 12 (22.6%) in the ARSIS group. Patients' clinical information, radiologic characteristics, recanalization rates, perioperative complications, and follow-up outcomes were compared between the 2 groups. RESULTS:Among these patients, the median interval from radiologic occlusion to recanalization was 35 days. Successful recanalization was achieved in a smaller proportion of the AWDEP group than in the ARSIS group (82.9% versus 100%, P = .29). The total number and length of implanted stents in the AWDEP group were significantly more in the ARSIS group (P = .009 and P = .007, respectively). The incidence of periprocedural complications and in-stent restenosis among patients undergoing the AWDEP technique was higher with the ARSIS technique (19.5% versus 0%, P = .23 and 26.5% versus 8.3%, P = .37, respectively). At 90-day follow-up, there was a greater trend toward better functional outcomes in the ARSIS group than in the AWDEP group (median mRS score: 0 [range, 0-1] versus 1 [range, 0-2], P = .07). CONCLUSIONS:Compared with the AWDEP technique, the ARSIS technique may be more beneficial for endovascular treatment of symptomatic nonacute LICAO, particularly in reducing the implanted stent burden. Prospective and multicenter studies are needed to further confirm the safety, efficacy, and durability of the ARSIS technique.

Objective Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is extensively used in neurointerventional procedures to prevent thromboembolic events. Intracranial aneurysm (IA) and cerebral artery stenosis (CAS) might exhibit different responses to DAPT because they have different pathophysiologies. In the present study, we compared IA and CAS patients in terms of ischemic and hemorrhagic complications after endovascular treatment maintained with DAPT. Methods We conducted a retrospective analysis of patients undergoing neurointerventional procedures at our center between August 2023 and September 2024. Clinical data, including DAPT regimens, baseline characteristics, and complications (ischemic or hemorrhagic), were systematically reviewed. Propensity score matching (PSM) was used to adjust for baseline differences between groups. Results A total of 991 patients (556 IA and 435 CAS) were enrolled. While IA patients and CAS patients demonstrated comparable rates of ischemic complications (2.3% vs. 1.1%, P = 0.131), the former showed a significantly higher incidence of hemorrhagic complications than the latter, particularly nuisance bleeding (NB) (45.7% vs. 15.9%, P < 0.001). There were significant differences in the prevalence of atherosclerosis risk factors and baseline characteristics between the two groups. After PSM (232 matched pairs), ischemic event rates remained similar between groups, while hemorrhagic complications remained more frequent in IA patients. Conclusion Our findings indicate that standard DAPT (aspirin 100mg/day + clopidogrel 75mg/day) appears appropriate for CAS patients but may be associated with increased NB risk in IA patients. These results underscore the need for condition-specific antiplatelet strategies in neurointerventional practice.

OBJECTIVES:Pre-endovascular identification of intracranial atherosclerotic stenosis - related large vessel occlusion (ICAS-LVO) is essential for optimizing recanalization strategy. This study aimed to develop a preoperative scale to predict ICAS-LVO in patients with acute vertebrobasilar artery occlusion (VBAO). METHODS:We retrospectively reviewed patients with acute VBAO who underwent endovascular thrombectomy at a single center between January 2015 and December 2024. The included patients were chronologically divided into a derivation cohort and a temporal internal validation cohort. ICAS-LVO was defined according to intra- or postprocedural angiographic findings. Candidate predictors were selected using a random forest approach, followed by regression-based model development. A prediction scale derived from the model was evaluated in both cohorts. RESULTS:A total of 196 patients were included for analysis, including 158 in the derivation cohort and 38 in the temporal internal validation cohort. Following random forest analysis, atrial fibrillation (AF), thrombus enhancement sign (TES), and occlusion site emerged as key predictors of ICAS-LVO. These variables were integrated into a multivariate logistic regression model. Subsequently, the ATO score - a weighted composite of these predictors - demonstrated robust discriminative performance, with an AUC of 0.939 (95% CI: 0.896-0.982, p < 0.001) in the derivation cohort and 0.929 (95% CI: 0.843-1.000, p < 0.001) in the temporal internal validation cohort. DISCUSSION:The ATO scale, which incorporates AF, TES, and the location of the occlusion site, may serve as a readily applicable instrument for predicting ICAS-LVO in VBAO patients before endovascular treatment.

Traditional imaging methods, like CT angiography (CTA), are unable to visualize the occluded vessels in acute ischemic stroke (AIS). We aimed to develop a deep learning based segmentation model for reconstructing the complete cerebral vasculature from non-contrast CT (NCCT) in LVO-AIS patients for endovascular thrombectomy planning. A nnU-Net model was trained and validated on retrospectively collected paired NCCT-CTA head images without large vessel occlusions (LVOs) from December 2018 to July 2025 (dataset 1: n = 280, for model training, internal validation and internal test; dataset 2: n = 40, for external validation). Model performance was evaluated using quantitative segmentation metrics, including the Dice Similarity Coefficient (DSC). Additionally, the model was evaluated on NCCT images of LVO-AIS patients from two hospitals, and the segmentation results were verified against post-recanalization DSA by two radiologists (dataset 3: n = 290). The nnU-Net model demonstrated robust segmentation performance, achieving DSC of 0.80 ± 0.04, 0.79 ± 0.04, and 0.79 ± 0.04 on the internal validation, internal test, and external validation sets, respectively. In the clinical evaluation involving LVO-AIS patients, high-quality segmentations were assigned by Rater 1 in 98.9

Background Acute vertebrobasilar artery occlusion is associated with mortality rates up to 80%. While endovascular thrombectomy has proven effective, patient selection remains challenging due to limited validated prediction models. This study aimed to develop and externally validate a nomogram for predicting 90-day excellent functional outcome (modified Rankin Scale score, 0-1) in patients with acute vertebrobasilar artery occlusion undergoing endovascular thrombectomy. Methods A total of 819 patients with vertebrobasilar artery occlusion undergoing endovascular thrombectomy were enrolled in this study. Of these, 242 patients from 4 stroke centers were allocated to the training cohort, while 577 patients from the PERSIST (Posterior Circulation Ischemic Stroke) registry comprised the validation cohort. Multivariate logistic regression identified independent predictors for nomogram development. Model performance was assessed using the concordance index, calibration curves, and decision curve analysis. Results The overall excellent outcome rate was 21.2%, with 85.1% achieving successful recanalization. Five independent predictors were identified: age <65 years (odds ratio [OR], 0.96; P=0.006), baseline National Institutes of Health Stroke Scale score <18 (OR, 0.97; P=0.012), thrombectomy passes <3 (OR, 0.59; P=0.033), Basilar Artery on Computed Tomography Angiography score >6 (OR, 1.34; P=0.028), and successful recanalization (OR, 4.49; P=0.019). The nomogram demonstrated excellent discriminative performance, with a concordance index of 0.82 in the training cohort and 0.92 in external validation. Good calibration was confirmed (Hosmer-Lemeshow test, P=0.514). Conclusions We developed and externally validated a practical nomogram incorporating 5 clinical variables for predicting excellent outcomes in patients with acute vertebrobasilar artery occlusion undergoing endovascular thrombectomy. The model demonstrates robust performance and clinical utility, providing valuable support for evidence-based decision making in posterior circulation stroke management.

To evaluate the incremental value of computed tomography (CT) imaging markers beyond clinical factors in predicting futile recanalization (FR) in patients with acute ischemic stroke (AIS) undergoing mechanical thrombectomy (MT), and to develop an integrated clinical-imaging nomogram for FR risk stratification. We enrolled 342 AIS patients who achieved successful recanalization—definded as a modified Thrombolysis in Cerebral Infarction grade ≥ 2b after MT—between October 2019 and December 2023. FR was defined as a poor outcome (modified Rankin Scale score 3–6) despite successful recanalization. Independent clinical and imaging predictors of FR were identified by multivariable logistic regression. The added value of CT imaging markers was assessed using integrated discrimination index (IDI) and continuous net reclassification improvement (NRI). Significant predictors were incorporated into a nomogram, and its discrimination and calibration were assessed. FR was observed in 161 patients (47.1

To evaluate whether endovascular thrombectomy (EVT) combined with best medical management (BMM) is more effective than BMM alone in treating mild stroke patients (National Institutes of Health Stroke Scale score < 6) with large vessel occlusion (LVO). A multicentric retrospective cohort of patients with LVO and mild stroke within 24 h from symptom onset was included. Patients were divided into the primary EVT (EVTpri) group and the primary BMM (BMMpri) group according to the treatment strategy. Functional outcomes were compared after propensity score matching. Additionally, adjusted logistic regression analysis was used to assess the association between treatment strategy and functional outcomes. Finally, 419 patients were included, with 137 receiving EVTpri and 282 receiving BMMpri. After propensity score matching (EVTpri, 126 vs. BMMpri, 126), baseline characteristics were balanced between the two groups. No significant difference was observed in 3-month functional independence (modified Rankin Scale [mRS] 0–2, 78.6

To determine the optimal saturation power for chemical exchange saturation transfer (CEST) imaging and evaluate the prognostic value of CEST parameters at different saturation powers in patients with acute ischemic stroke (AIS). Seventy-nine AIS patients underwent CEST imaging at saturation powers of 1, 1.5, and 2 μT. Amide proton transfer (APT#) and nuclear overhauser enhancement (NOE#) signals were quantified using the numerical fitting of the extrapolated semi-solid magnetization transfer reference (NEMR) method and compared to conventional amide proton transfer-weighted (APTw) signals based on the magnetization transfer ratio asymmetry at 3.5 ppm. Infarction visibility and hypointense artifacts on APT#, NOE#, and APTw images were graded on a three-point scale and compared using the Friedman test. Independent t-tests were used to compare CEST parameters between patients with favorable and unfavorable outcomes at 90 days. Hypointense artifacts were most pronounced at 2 μT and minimized at 1 μT on APT# and NOE# images (p < 0.001). Infarctions were best visualized at 1 μT in 78.6

ABSTRACT Introduction To evaluate left atrial (LA) function in patients with embolic stroke of undetermined source (ESUS) and other subtypes of acute ischemic stroke (AIS) related to large‐vessel occlusion (LVO). Methods Consecutive patients with LVO‐related AIS were prospectively enrolled from July 2019 to August 2022. To compare LA function with ESUS patients, a control group without prior stroke was sex‐ and age‐matched with ESUS patients in a 1:1 ratio. LA strain was measured within 3 days after stroke. Multivariable logistic regression analysis was performed to assess associations between LA function and stroke subtypes. Results This study included 126 patients (mean age 67.7 ± 12.3 year, 39.7% women). Of these, 28 patients met the diagnostic criteria for ESUS, while the remaining were classified as large artery atherosclerosis (n = 49) and non‐valvular AF‐related cardioembolic stroke (n = 49). Patients with ESUS had lower left atrial reservoir strain (LASr) and left atrial conduit strain (LAScd) compared to those with large artery atherosclerosis (27.8 ± 7.1% vs. 32.0 ± 5.3%, p = 0.004, and 14.3 ± 3.8% vs. 17.3 ± 4.6%, p = 0.005, respectively) and the control group (27.8 ± 7.1% vs. 37.6 ± 7.2%, p < 0.001 and 14.3 ± 3.8% vs. 21.5 ± 7.9%, p < 0.001, respectively). A 5% reduction in LASr and LAScd was associated with a 1.92‐ and 2.45‐fold increase, respectively, in the likelihood of having ESUS compared to large artery atherosclerosis. Lower LASr and LAScd in ESUS patients were prone to be associated with a higher likelihood of cardiovascular events during follow‐up. Conclusions LA strain is associated with ESUS in stroke patients with LVO. Further studies are needed to explore its utility in identifying specific stroke etiologies.

OBJECTIVE:The management of flow-related aneurysms (FRAs) associated with infratentorial arteriovenous malformations (AVMs) remains challenging and controversial. In this study, we present our clinical experience with endovascular treatment of these complex lesions. METHODS:We retrospectively analyzed 25 consecutive patients with ruptured or symptomatic FRAs treated between January 2020 and June 2024. Treatment was tailored to FRA location: proximal FRAs underwent coil embolization to preserve distal flow, while distal FRAs received liquid embolics, often requiring parent artery sacrifice. Clinical outcomes, radiological findings, and treatment approaches were systematically reviewed. RESULTS:Hemorrhage was the most common presenting symptom (19/25, 76.0%), with FRA rupture accounting for 15 cases and AVM nidus bleeding for the remaining 4. Endovascular treatment was performed for 37 FRAs, with proximal aneurysms predominantly managed by coiling (21/22, 95.5%) to preserve distal perfusion, while distal FRAs were primarily treated with liquid embolics (14/15, 93.3%) via feeder sacrifice. Three (12.0%) clinically significant complications occurred, including 2 ischemic events and one case of hydrocephalus. At a mean follow-up of 22.1 months, 24 patients (96.0%) achieved favorable outcomes (modified Rankin Scale ≤2). One patient experienced rebleeding due to enlargement and rupture of an untreated FRA 3 years post-treatment. CONCLUSIONS:The natural history of FRAs associated with AVMs remains unpredictable. We recommend aggressive treatment in all cases unless complete AVM occlusion is achieved. Endovascular treatment represents a safe and effective primary therapeutic approach for infratentorial AVM-associated FRAs.

This study aimed to evaluate the efficiency and safety of stent-assisted repeated aspiration thrombectomy (SARA) in treating cerebral venous sinus thrombosis (CVST). We conducted a retrospective analysis of 13 CVST patients treated with the SARA technique between May 2020 and May 2024. Outcomes assessed included technical recanalization rates, procedure-related complications, symptomatic intracranial hemorrhage and functional outcomes at 90 days. The mean procedure time was 159.9 ± 22.4 (95

OBJECTIVE:To compare the embolization outcomes and complications of the LEO Baby and Neuroform Atlas stents in the endovascular treatment of intracranial wide-neck aneurysms. METHODS:We identified patients with intracranial aneurysms treated with LEO Baby (n = 163) or Atlas (n = 65) stent-assisted coiling between October 2018 and February 2023. A retrospective analysis of demographics, aneurysm characteristics, embolization outcomes, and procedure-related complications was performed. Propensity score matching analysis with a ratio of 1:2 was used to balance the patient selection bias that existed between the 2 cohorts. RESULTS:Compared to the Atlas cohort, the LEO Baby cohort had a higher rate of immediate successful embolization (95.6% vs. 78.5%, P < 0.001) and a lower rate of incomplete embolization at midterm follow-up (4.0% vs. 18.6%, P = 0.006), but there was no significant difference for either after matching for a 1:2 propensity score (P = 0.091 and P = 0.081, respectively). Procedure-related complications were 10.4% (17/163) in the LEO Baby cohort and 7.7% (5/65) in the Atlas cohort. At midterm angiographic follow-up, recanalization occurred in 0.8% (1/124) of the LEO Baby cohort and 4.7% (2/43) of the Atlas cohort. Complication and recanalization rates for both stents were not statistically different before (P = 0.701 and P = 0.332, respectively) and after (P > 0.999 and P > 0.999, respectively) propensity score matching. CONCLUSIONS:Both LEO Baby and Atlas are safe and effective in the treatment of intracranial aneurysms, and they are similar in terms of aneurysm embolization outcomes and complication rates.

Malignant middle cerebral artery infarction (mMCAi) is a life-threatening complication after large hemispheric infarction. This study aimed to develop a nomogram combining clinical and Computed Tomography Perfusion (CTP) parameters to predict the risk of mMCAi in patients with large core infarction following endovascular treatment (EVT). We retrospectively analyzed patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO) and large core infarction treated with EVT between January 2019 and June 2024. Demographic, clinical, imaging, and procedural data were collected. Multivariate logistic regression with forward elimination identified independent predictors of mMCAi. A nomogram was constructed based on these predictors, and its performance was assessed using the area under the receiver operating characteristic curve (AUC) and calibration analysis. Among 179 patients, 45 (25.2

BACKGROUND AND PURPOSE:It remains unclear whether the combination of endovascular treatment (EVT) with intravenous thrombolysis (IVT) results in a more favorable functional outcome than EVT alone in managing cases of acute ischemic stroke (AIS) caused by basilar artery occlusion (BAO). Thus, this study aimed to compare the outcomes of 2 approaches-direct endovascular treatment (DEVT) and bridging therapy (IVT plus EVT)-in patients with acute BAO presenting within 4.5 hours of stroke onset. MATERIALS AND METHODS:This multicenter retrospective cohort study included 153 patients with acute BAO presenting within 4.5 hours of stroke onset. Of these patients, 65 (42.5%) and 88 (57.5%) underwent DEVT and bridging therapy, respectively. The primary outcome was defined as good functional outcome (mRS, 0-3) at 90 days. Additionally, preoperative clinical features, thrombectomy attempts, successful reperfusion rates, incidences of symptomatic intracranial hemorrhage (sICH), and mortality were compared between the 2 groups. RESULTS:At 90 days, the rate of good functional outcome was comparable between the DEVT (44.6%) and bridging-therapy (39.8%) groups (adjusted odds ratio [aOR], 1.12; 95% CI, 0.55-2.31; P = .753). The bridging-therapy group exhibited a lower percentage of patients requiring ≥3 attempts of stent retrieval (aOR, 0.39; 95% CI, 0.16-0.93; P = .034). Preoperative clinical features, rate of successful reperfusion, sICH, and mortality were similar between the 2 groups. CONCLUSIONS:In patients with BAO-induced AIS, DEVT demonstrates a comparable functional outcome to bridging therapy within 4.5 hours of symptom onset, but IVT reduces the number of thrombectomy attempts.

While CT perfusion (CTP) is the current standard for endovascular thrombectomy (EVT) selection in extended time windows with acute ischemic stroke with large vessel occlusion (LVO-AIS), the added prognostic value of CTP over non-contrast CT (NCCT)-based models remains debated, particularly when combined with clinical variables. In this dual-center retrospective cohort study, we analyzed 216 consecutive anterior circulation LVO-AIS patients undergoing EVT between May 2021 and March 2024. Univariate and multivariate analysis were performed on both NCCT-derived and CTP-derived imaging parameters alongside clinical variables, with 90-day functional independence (modified Rankin Scale [mRS] 0–2) as primary endpoint. The ROC curves of the two models were computed using 5-fold cross-validation, and differences in the area under the curve (AUC) were evaluated using DeLong’s test. Functional independence (mRS 0–2) was achieved in 42.6

Background In-stent restenosis (ISR) is a potential severe complication that occurs in patients with severe carotid artery narrowing after carotid angioplasty and stent placement. However, this phenomenon has not been fully studied in the context of interventional treatment for chronic internal carotid artery occlusion (CICAO). Purpose To quantify the ISR rate and identify the risk factors leading to this event. Material and Methods This study included 69 patients with symptomatic CICAO who underwent successful intravascular recanalization at our institution. Clinical information, outcomes, and prognosis of the patients were recorded. The related factors of ISR were analyzed through univariate and multivariate analysis. Results A total of 11 (15.9%) patients developed a significant ISR > 70% during the follow-up period. Among them, five patients with ISR experienced symptomatic restenosis. Our study found hyperlipidemia ( P = 0.017), contralateral internal carotid artery occlusion ( P = 0.041), and prolonged radiologic occlusion to recanalization time ( P = 0.049) could contribute to the risk of ISR in patients with CICAO. Conclusion ISR is not rare in patients with CICAO after successful intervention. Hyperlipidemia, contralateral ICA occlusion, and prolonged radiologic occlusion to recanalization time are the risk factors for ISR after treatment in patients with CICAO.

ObjectiveTo report periprocedural thromboembolic complications of LEO Baby stent-assisted coiling of wide-necked intracranial aneurysms and to analyze the possible influencing factors.MethodsWe retrospectively identified 149 patients with aneurysms who underwent LEO Baby stent-assisted embolization between October 2018 and March 2022. Clinical and radiographic data of patients were reviewed to determine whether a thromboembolic event had occurred. Multivariate logistic analysis was performed to identify significant factors associated with thromboembolic events.ResultsSuccessful stent deployment of the stent was achieved in all patients in the target artery. There were 66 patients (44.3%) with acutely ruptured aneurysms and 83 patients (55.7%) with unruptured aneurysms. Fourteen (9.4%, 95% confidence interval: 4.7%-14.1%) patients were confirmed to have developed a thromboembolic event, including nine patients with acute intraoperative thrombosis and five patients with postoperative thromboembolic events. The rate of thromboembolic events was 6.0% (5/83) in patients with unruptured aneurysms and 13.6% (9/66) in patients with acutely ruptured aneurysms. There was a trend toward an increased rate of thromboembolic events in patients with acute ruptured aneurysms (p = 0.087). Thromboembolic events were significantly associated with the parent-artery diameter (p = 0.010).ConclusionsOur study demonstrates a low rate of thromboembolic complications in unruptured aneurysms treated with LEO Baby stent. Thromboembolic events appear to be more common in ruptured aneurysms. A small diameter of the parent artery is associated with an increased risk of thromboembolic complications, and more relevant studies are still needed.

Perfusion imaging is useful to assess tissue recovery in patients with acute ischemic stroke (AIS); however, it cannot reflect tissue metabolism. We postulated that amide proton transfer (APT) imaging can characterize the tissue status after reperfusion therapy, thus providing prognostic value for 90-day functional outcomes. We included 63 patients with AIS and large-vessel occlusion (LVO). The APT signals, including APT# and NOE# (nuclear Overhauser enhancement) were quantified. Ischemic lesions observed on APT# and diffusion-weighted imaging (DWI) were classified according to their mismatch patterns (APT# < DWI; APT# ≥ DWI). Predictors of 90-day good outcomes (modified Rankin scale score 0-2) were evaluated. Patients with successful reperfusion exhibited higher APT#, smaller percentage change of APT#, and a greater likelihood of presenting APT# < DWI compared to those with poor reperfusion (all P < 0.05). The APT# (odds ratio [OR] = 11.48, P = 0.046) and a mismatch pattern of APT# < DWI (OR = 7.41, P = 0.020) independently predicted good outcomes besides the clinical parameters. A mismatch pattern of APT# ≥ DWI was a significant marker of poor outcomes despite successful reperfusion (P = 0.002). Our study provides preliminary evidence that APT may reveal tissue recovery after reperfusion and predict good outcomes at 90 days in patients with AIS and LVO.

This research aimed to assess the prognostic relevance of the hypoperfusion intensity ratio (HIR) concerning 90-day outcomes in patients with acute ischemic stroke (AIS) managed within the early intervention window. A retrospective review was conducted on AIS patients who received pretreatment computed tomography perfusion imaging and endovascular thrombectomy due to large vessel occlusions in the anterior circulation between January 2020 and September 2022. Clinical data, including the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) from non-contrast CT, along with perfusion metrics such as ischemic core, hypoperfusion extent, core-penumbra mismatch, and HIR, were analyzed. Patients were divided into groups with favorable (modified Rankin Scale score 0-2) and unfavorable outcomes (modified Rankin Scale score 3-6). Among the 187 patients evaluated, 95 (50.8%) had favorable outcomes. Univariate analysis showed significant associations between functional outcomes and variables like age, National Institutes of Health Stroke Scale score at admission, ASPECTS, HIR, ischemic core volume, and hypoperfusion volume (P < .05). Multivariate analysis revealed that younger age (odds ratio [OR] 1.064; 95% confidence interval [CI] 1.025-1.106, P = .001), lower National Institutes of Health Stroke Scale score at admission (OR 1.116; 95% CI 1.038-1.199, P = .003), smaller ischemic core volume (OR 1.017; 95% CI 1.002-1.033, P = .029), higher ASPECTS (OR 0.800; 95% CI 0.662-0.967, P = .021), and reduced HIR (OR 1.516; 95% CI 1.230-1.869, P = .001) independently predicted favorable outcomes at 90 days. Lower HIR was independently linked to improved functional outcomes in AIS patients receiving endovascular thrombectomy within the early intervention timeframe.