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Updated: Aug 21, 2026
Transient Middle Cerebral Artery Occlusion Model of Stroke
Published on: August 11, 2023
Influence of the site of arterial occlusion on multiple baseline hemodynamic MRI parameters and post-thrombolytic
L Derex1, M Hermier, P Adeleine
1Service d'Urgences NeuroVasculaires, Hôpital Neurologique, 59 Boulevard Pinel, 69003, Lyon, France. laurent.derex@chu-lyon.fr
Abstract:
In this prospective MRI study, we evaluated the impact of the site of occlusion on multiple baseline perfusion parameters and subsequent recanalization in 49 stroke patients who were given intravenous tissue plasminogen activator (tPA). Pretreatment magnetic resonance angiography (MRA) revealed an arterial occlusion in 47 patients: (1) internal carotid artery (ICA) + M1 middle cerebral artery (MCA) occlusion (n=12); (2) M1 MCA occlusion (n=19); (3) M2 MCA, distal branches of the MCA and anterior cerebral artery (ACA) occlusion (n=16). Patients with ICA occlusion had significantly larger DWI, PWI and mismatch lesion volume on pretreatment MRI compared to patients with other sites of occlusion. The differences in cerebral blood flow (CBF) and peak height were significantly higher in patients with ICA occlusion compared to patients with other sites of occlusion (P=0.03 and P=0.04, respectively). Day 1 MRA showed recanalization in 28 patients (60%). The rate of recanalization was significantly different depending on the site of occlusion: 33% in ICA + M1 MCA occlusion, 63% in M1 MCA occlusion and 81% in either M2 MCA, distal branches of the MCA or ACA occlusion (P=0.002). Our data suggest that CBF and peak height are the most relevant MRI parameters to assess the severity of hemodynamic impairment in regard to the site of occlusion.
Insights
The location of arterial occlusion in stroke patients impacts recanalization rates after intravenous tissue plasminogen activator (tPA) therapy. Cerebral blood flow and peak height on MRI predict hemodynamic impairment severity.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Medicine
Background:
- Stroke is a leading cause of disability, necessitating effective treatments.
- Intravenous tissue plasminogen activator (tPA) is a key therapy for acute ischemic stroke.
- Understanding factors influencing tPA efficacy, such as occlusion site, is crucial.
Purpose of the Study:
- To investigate the influence of arterial occlusion site on perfusion parameters and recanalization after tPA in stroke patients.
- To identify MRI parameters that best predict hemodynamic impairment based on occlusion location.
Main Methods:
- Prospective MRI study of 49 acute ischemic stroke patients treated with intravenous tPA.
- Pretreatment magnetic resonance angiography (MRA) categorized occlusion sites: internal carotid artery (ICA) + M1 middle cerebral artery (MCA), M1 MCA, or M2 MCA/distal branches/anterior cerebral artery (ACA).
- Evaluated diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI), mismatch lesion volume, cerebral blood flow (CBF), and peak height; assessed recanalization via Day 1 MRA.
Main Results:
- Patients with ICA occlusion had larger baseline DWI, PWI, and mismatch volumes.
- Significantly higher CBF and peak height were observed in ICA occlusion patients (P=0.03 and P=0.04).
- Recanalization rates varied significantly by occlusion site: 33% (ICA+M1 MCA), 63% (M1 MCA), and 81% (M2 MCA/distal/ACA) (P=0.002).
Conclusions:
- The site of arterial occlusion significantly affects recanalization rates following tPA treatment.
- Cerebral blood flow (CBF) and peak height are key MRI parameters for assessing hemodynamic impairment severity relative to occlusion site.