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Rapid Apparent Diffusion Coefficient Evolution After Early Revascularization.

Amie W Hsia1,2, Marie Luby1, Kaylie Cullison1

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Endovascular therapy (EVT) in acute ischemic stroke patients leads to faster apparent diffusion coefficient (ADC) normalization, indicating potential secondary injury. This early ADC change correlates with better clinical outcomes and core reversal after revascularization.

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biomarkersembolectomyischemiamagnetic resonance imagingreperfusionstroke

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Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Endovascular therapy (EVT) has advanced acute ischemic stroke treatment.
  • Early and complete reperfusion is a key goal in EVT.
  • Apparent Diffusion Coefficient (ADC) normalization kinetics differ with EVT compared to historical controls.

Purpose of the Study:

  • To evaluate the effect of revascularization on ADC evolution within the core lesion in the first 24 hours post-stroke.
  • To compare ADC changes in patients treated with EVT versus intravenous thrombolysis (IVT)-only.
  • To assess the correlation between early ADC changes and clinical outcomes.

Main Methods:

  • Retrospective study of anterior circulation acute ischemic stroke patients.
  • Comparison between EVT (with or without IVT) and IVT-only cohorts.
  • Quantification of diffusion-weighted imaging (DWI) and ADC maps for core lesions.
  • Measurement of median ADC value change, core reversal, and DWI lesion growth at 24 hours and 5 days.

Main Results:

  • Revascularization patients showed a significant increase in median ADC value at 24 hours, unlike non-revascularization patients.
  • Revascularization was associated with a significantly higher rate of good clinical outcome (modified Rankin Scale 0-2) at 90 days (63% vs. 9%).
  • Core reversal at 24 hours was significantly higher in revascularization patients (69% vs. 22%).

Conclusions:

  • Early, complete revascularization with EVT alters ADC evolution in acute ischemic stroke.
  • Observed early ADC normalization may indicate secondary injury and warrants further investigation.
  • ADC evolution serves as a potential imaging biomarker for adjunctive therapies in stroke treatment.