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Published on: January 18, 2018
Fate of the penumbra after mechanical thrombectomy
B Friedrich1, O Kertels2, D Bach2
1From the Departments of Neuroradiology (B.F., O.K., D.B., C.Z., S.P., A.F.) benjamin.friedrich@tum.de.
Insights
Mechanical thrombectomy effectively rescues brain tissue in acute stroke patients. Successful reperfusion significantly reduces final infarct size and improves clinical outcomes, highlighting its importance in stroke treatment.
Area of Science:
- Neurology
- Interventional Radiology
- Neuroscience
Background:
- Acute stroke management relies on timely reperfusion to salvage brain tissue.
- Cerebral perfusion imaging (CTP) visualizes ischemic core and penumbra, guiding treatment decisions.
- Mechanical thrombectomy is a key intervention for acute ischemic stroke.
Purpose of the Study:
- To evaluate infarct evolution after mechanical thrombectomy in anterior circulation stroke.
- To identify interventional factors influencing penumbra fate and final infarct size.
- To correlate recanalization success with clinical outcomes and infarct volume.
Main Methods:
- Retrospective analysis of 73 patients undergoing mechanical thrombectomy with pre-procedural CTP.
- Correlation of clinical parameters, intervention success (TICI score), and CTP data with final infarct volume.
- Assessment of infarct core, penumbra, and salvageable tissue using CTP parameters.
Main Results:
- 78.1% of patients achieved successful reperfusion (TICI 3/2b).
- Successful reperfusion (TICI 3/2b) correlated with significantly smaller final infarct volumes (19.6 cm³ vs. 38.1 cm³).
- Higher reperfusion rates (TICI 3/2b) salvaged significantly more brain tissue (81% vs. 39%) and improved NIHSS scores more effectively.
Conclusions:
- Mechanical thrombectomy is a highly effective treatment for rescuing penumbral tissue in acute ischemic stroke.
- Achieving successful reperfusion (TICI 3/2b) is critical for minimizing infarct size and improving patient outcomes.
- CTP is valuable for assessing infarct evolution and guiding thrombectomy interventions.
Background And Purpose:
In acute stroke, CTP is often used to visualize the endangered brain areas, including the ischemic core and the penumbra. Our goal was to assess the evolution of the infarct after mechanical thrombectomy and to analyze the interventional factors determining the fate of the penumbra.
Materials And Methods:
All patients receiving mechanical thrombectomy in the anterior circulation and receiving CTP beforehand were identified. The infarct volume was specified. The clinical parameters, outcome, and interventional results were correlated with the CTP and the final infarct size.
Results:
In total, 73 patients were included. After mechanical thrombectomy, 78.1% reached a TICI score of 3/2b. The final infarct volume was significantly smaller, with a TICI score of 3/2b compared with less sufficient recanalization (19.60 ± 3 cm(3) versus 38.1 ± 9 cm(3); P < .001). After TICI 3/2b recanalization, 81% ± 5.2% of the potential infarct size (calculated as the sum of infarct core and penumbra) could be rescued. In patients with TICI scores of 2a or worse, only 39 ± 28.3 were salvaged (P < .001). The Alberta Stroke Program Early CT Score after successful recanalization TICI score of 3/2b resulted in a decline of 1.9 ± 1.4 compared with the significantly higher degradation score of 3.7 ± 1.7 after recanalization, with a TICI score of 2a or worse. A recanalization TICI score of 3/2b resulted in an NIHSS improvement of 7.3 ± 0.8 NIHSS points, whereas a poorer recanalization improved on the NIHSS by only 2.5 ± 1.5 points (P < .01).
Conclusions:
Mechanical thrombectomy is a potent method to rescue large areas of penumbra in acute stroke.
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