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Updated: May 2, 2026
Optimization of the Longa Middle Cerebral Artery Occlusion Method for Complete Reperfusion
Published on: November 22, 2024
Early diffusion-weighted imaging reversal after endovascular reperfusion is typically transient in patients imaged 3
Manabu Inoue1, Michael Mlynash, Soren Christensen
1From the Stanford Stroke Center, Stanford University School of Medicine, CA.
Background And Purpose:
The aim of this study was to assess the frequency and extent of early diffusion-weighted imaging (DWI) lesion reversal after endovascular therapy and to determine whether early reversal is sustained or transient.
Methods:
MRI with DWI perfusion imaging was performed before (DWI 1) and within 12 hours after (DWI 2) endovascular treatment; follow-up MRI was obtained on day 5. Both DWIs were coregistered to follow-up MRI. Early DWI reversal was defined as the volume of the DWI 1 lesion that was not superimposed on the DWI 2 lesion. Permanent reversal was the volume of the DWI 1 lesion not superimposed on the day 5 infarct volume. Associations between early DWI reversal and clinical outcomes in patients with and without reperfusion were assessed.
Results:
A total of 110 patients had technically adequate DWI before endovascular therapy (performed median [interquartile range], 4.5 [2.8-6.2] hours after onset); 60 were eligible for this study. Thirty-two percent had early DWI reversal >10 mL; 17% had sustained reversal. The median volume of permanent reversal at 5 days was 3 mL (interquartile range, 1.7-7.0). Only 2 patients (3%) had a final infarct volume that was smaller than their baseline DWI lesion. Early DWI reversal was not an independent predictor of clinical outcome and was not associated with early reperfusion.
Conclusions:
Early DWI reversal occurred in about one third of patients after endovascular therapy; however, reversal was often transient and was not associated with a significant volume of tissue salvage or favorable clinical outcome.
Insights
Early diffusion-weighted imaging (DWI) lesion reversal after endovascular therapy occurs in about one third of patients but is often transient. This early reversal did not significantly improve tissue salvage or clinical outcomes.
Area of Science:
- Neurology
- Radiology
- Interventional Medicine
Background:
- Assessing early diffusion-weighted imaging (DWI) lesion changes after endovascular therapy is crucial for understanding treatment efficacy.
- Early DWI lesion reversal, the reduction in lesion volume shortly after treatment, requires further investigation regarding its persistence and clinical significance.
Purpose of the Study:
- To determine the frequency and extent of early DWI lesion reversal following endovascular therapy.
- To evaluate whether this early reversal is sustained over time or transient.
- To explore the association between early DWI reversal and clinical outcomes.
Main Methods:
- Magnetic resonance imaging (MRI) with DWI perfusion imaging was conducted before (DWI 1) and within 12 hours after (DWI 2) endovascular treatment.
- Follow-up MRI was performed on day 5 to assess permanent reversal.
- Early and permanent DWI reversal volumes were calculated, and associations with clinical outcomes and reperfusion status were analyzed.
Main Results:
- Thirty-two percent of eligible patients exhibited early DWI reversal exceeding 10 mL; only 17% showed sustained reversal.
- The median permanent reversal volume at 5 days was 3 mL.
- Early DWI reversal was not an independent predictor of clinical outcome and showed no association with early reperfusion.
Conclusions:
- Early DWI lesion reversal is observed in approximately one-third of patients post-endovascular therapy.
- However, this reversal is frequently transient and does not correlate with substantial tissue salvage or improved clinical outcomes.
- The findings suggest that early DWI reversal alone is not a reliable indicator of successful endovascular treatment.
