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19.02.2018 | Original Article

Complete Restitution of the Ischemic Penumbra after Successful Thrombectomy

A Pilot Study Using Quantitative MRI

verfasst von: Alexander Seiler, Arne Lauer, Ralf Deichmann, Ulrike Nöth, Se-Jong You, Waltraud Pfeilschifter, Oliver C. Singer, Ulrich Pilatus, Marlies Wagner

Erschienen in: Clinical Neuroradiology | Ausgabe 3/2019

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Abstract

Purpose

Endovascular thrombectomy is highly effective in patients with proximal large artery occlusion but the relevance of reperfusion injury after recanalization is a matter of debate. The aim of this study was to investigate potential residual metabolic distress and microstructural tissue damage or edema after reperfusion using quantitative oxygen-sensitive T2′ and T2-mapping in patients successfully treated by thrombectomy.

Methods

Included in this study were 11 patients (mean age 70 ± 11.4 years) with acute ischemic stroke due to internal carotid artery and/or middle cerebral artery occlusion. Quantitative T2 and T2′ (1/T2′ = 1/T2* − 1/T2) were determined within the ischemic core and hypoperfused but salvaged tissue with delayed time-to-peak (TTP) in patients before and after successful thrombectomy and compared to a control region within the unaffected hemisphere.

Results

Decreased T2′ values within hypoperfused tissue before thrombectomy showed a normalization after recanalization (p < 0.01). In formerly hypoperfused but salvaged tissue, T2 values increased significantly after thrombectomy (p < 0.05) but did not differ from reference values in the control region. In salvaged tissue, increases of quantitative T2′ and T2 to follow-up were more pronounced in areas with severe TTP delay.

Conclusion

After successful recanalization, T2′ re-increased back to normal in formerly hypoperfused areas as a sign of prompt normalization of oxygen metabolism. Furthermore, quantitative T2 in the formerly hypoperfused tissue did not differ from reference values in unaffected tissue. These results indicate complete restitution of salvaged tissue after reperfusion and support the overall safety of endovascular thrombectomy with respect to microstructural tissue integrity.

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Titel: Complete Restitution of the Ischemic Penumbra after Successful Thrombectomy
A Pilot Study Using Quantitative MRI
verfasst von: Alexander Seiler
Arne Lauer
Ralf Deichmann
Ulrike Nöth
Se-Jong You
Waltraud Pfeilschifter
Oliver C. Singer
Ulrich Pilatus
Marlies Wagner
Publikationsdatum: 19.02.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Clinical Neuroradiology / Ausgabe 3/2019
Print ISSN: 1869-1439
Elektronische ISSN: 1869-1447
DOI: https://doi.org/10.1007/s00062-018-0675-3

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Complete Restitution of the Ischemic Penumbra after Successful Thrombectomy

A Pilot Study Using Quantitative MRI