Related Experiment Video
Updated: Aug 29, 2026
Transient Middle Cerebral Artery Occlusion Model of Stroke
Published on: August 11, 2023
Effect of incomplete (spontaneous and postthrombolytic) recanalization after middle cerebral artery occlusion: a
T Neumann-Haefelin1, R du Mesnil de Rochemont, J B Fiebach
1Department of Neurology, University Hospitals, Frankfurt, Germany. tnh@rz.uni-frankfurt.de
Background And Purpose:
Early reperfusion is one of the best predictors of good outcome after acute middle cerebral artery (MCA) occlusion. The purpose of this study was to analyze the frequency and relevance of incomplete recanalization for tissue and clinical outcome.
Methods:
From a larger acute stroke database (Kompetenznetzwerk Schlaganfall B5), all patients (n=82) with MCA main stem occlusion (excluding carotid T-occlusions) were selected. These patients had received a multiparametric stroke MRI protocol including diffusion- and perfusion-weighted imaging (DWI, PWI) and MR angiography (MRA) within 6 hours after symptom onset, at day 1 and after 1 week. Recanalization status was determined with MRA on day 1 (according to Thrombolysis In Myocardial Infarction flow grades) and used to group patients into those with persistent occlusion (0) or minimal (1), partial (2), or complete (3) recanalization.
Results:
Incomplete recanalization according to MRI criteria was found in 39 patients (grade 1: n=20; grade 2: n=19), complete recanalization in 10, and persistent occlusion in 33. There was no statistically significant difference in any of the clinical (National Institutes of Health Stroke Scale score) or MRI baseline parameters (DWI lesion, PWI deficit, mismatch volume, mismatch ratio). However, lesion growth was smaller in patients with recanalization (even in patients with only minimal recanalization) and outcome was related to the degree of recanalization (mean modified Rankin score at 90 days: 3.36, 2.70, 1.79, and 1.44 for the groups with no, minimal, partial, and complete recanalization, respectively). Both incomplete and complete recanalization was more frequent in patients receiving thrombolysis.
Conclusions:
Incomplete recanalization on day 1 is a frequent MR finding after MCA main stem occlusion, indicating a more favorable clinical course than persistent occlusion. MR indicators of early recanalization could be useful surrogates of efficacy in thrombolytic trials.
Insights
Incomplete recanalization after middle cerebral artery (MCA) occlusion is common and predicts a better outcome. Even minimal recanalization improves results compared to persistent occlusion, suggesting its value in stroke treatment.
Area of Science:
- Neuroscience
- Radiology
- Cardiovascular Medicine
Background:
- Early reperfusion is crucial for favorable outcomes in acute middle cerebral artery (MCA) occlusion.
- Analyzing incomplete recanalization is key to understanding tissue and clinical outcomes.
Purpose of the Study:
- To determine the frequency of incomplete recanalization after acute MCA occlusion.
- To assess the relevance of incomplete recanalization for tissue and clinical outcomes.
Main Methods:
- 82 patients with MCA main stem occlusion were studied using multiparametric MRI (DWI, PWI, MRA) within 6 hours of symptom onset.
- Recanalization status was assessed by MRA on day 1, categorizing patients into persistent occlusion or minimal, partial, and complete recanalization.
- Clinical and MRI parameters were compared across recanalization groups.
Main Results:
- Incomplete recanalization (grades 1-2) occurred in 39 patients, complete in 10, and persistent occlusion in 33.
- Recanalization, even minimal, was associated with smaller lesion growth and better clinical outcomes (modified Rankin Scale scores).
- Thrombolysis was linked to a higher frequency of both incomplete and complete recanalization.
Conclusions:
- Incomplete recanalization is a frequent finding on day 1 MRI after MCA occlusion and indicates a more favorable clinical course.
- MRI-based recanalization assessment can serve as a surrogate marker for treatment efficacy in clinical trials.
