1. Simple CBF grading based on MR perfusion to anticipate long-term clinical outcome in severe stroke patients due to the carotid artery occlusion Mori T, MD, PhD, Iwata T, MD, Tanno Y, MD, Kasakura S, MD, Yoshioka K, MD Department of Stroke Treatment Shonan Kamakura General Hospital Stroke Center

2. Financial Disclosure None

3. Background and Purpose Acute stroke Patients with the carotid artery occlusion Assessment of collaterals Long-term survival rate (SR) Long-term clinical outcome Appropriate treatments Simple CBF grading for whole MCA territory from MR perfusion

4. Patients 1)admitted to our institution within 24 hours of onset 2)between Jan 2005 and May 2014, 3)who presented symptoms of NIHSS of 5 or more, 4)MRA displaying occlusion of the carotid artery (CA) 5)No reperfusion therapy

5. MR perfusion and Time Intensity Curve Affected ac Contralateral Affected Contralateral affected CBF%; 23.6 %

6. Time Intensity Curve from PWI Simple CBF grading grade 1 : CBF% ＜ 0.2 grade 2: 0.2 ＝＜ CBF% ＜ 0.6 grade 3: 0.6 ＝＜ CBF ％ CBF ％ ; CBFa / CBFc CBFa; PSa/TPa, CBFc; PSc/TPc

7. Lt Rt CBF%; 4.4% CBF grade 1

8. CBF grade 2 Lt Rt CBF%; 23.6 %

9. CBF grade 3 Lt Rt CBF%; 72.6%

10. Results N63 Age (median)79 (70-86) y.o. Female36 ASPECTS (median)3 (1-5) CBF grade 1 grade 2 grade 3 25 13 NIHSS on admission (median) 21 (16-23) Onset-to-door time (median)1.8 (1.0-8.3) hrs Death within 4 months 35 （ 55.6% ）

11. K-M estimation of Survival Probability (n=63) Log rank; p<0.001 grade 1 (n=25) grade 2 (n=25) grade 3 (n=13) (days) Survival probability 20% 50.4% 76.2% Log rank; p<0.001

12. Clinical outcome at 90 days P<0.0001 mRS: 0-2mRS: 3-4mRS:5-6 grade 1 0124 grade 2 0718 grade 3 184

13. Conclusions Simple CBF grades for whole MCA territory can anticipate long-term survival rate and clinical outcome. Patients with grade 1 must be rescued to survive. Clinical outcome of patients with grade 2 or 3 must be improved.