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Exploring Reperfusion Following Endovascular Thrombectomy.

Jayme C Kosior1, Brian Buck1, Robert Wannamaker1

  • 1From the Division of Neurology (J.C.K, B.B., R.W., N.A.L., K.B.), University of Alberta, Edmonton, Canada.

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Summary

Post-endovascular thrombectomy (EVT) cerebral perfusion imaging using digital subtraction angiography (DSA) can predict hemorrhagic transformation (HT) in acute ischemic stroke patients. This novel technique offers valuable prognostic insights beyond standard assessments.

Keywords:
cerebral infarctionperfusion imagingreperfusionstroke thrombectomy

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Area of Science:

  • Neuroimaging
  • Cerebrovascular Diseases
  • Interventional Neurology

Background:

  • Cerebral perfusion assessment is crucial in acute ischemic stroke management before endovascular thrombectomy (EVT).
  • Post-EVT perfusion evaluation is infrequently performed but may offer significant prognostic value.
  • Current methods lack quantitative perfusion analysis from digital subtraction angiography (DSA) data post-EVT.

Purpose of the Study:

  • To develop a tool for quantitative perfusion measurements from post-EVT DSA data.
  • To investigate the prognostic utility of post-EVT perfusion in predicting outcomes like hemorrhagic transformation (HT).
  • To assess the relationship between mean transit time (MTT) and the development of HT.

Main Methods:

  • Retrospective analysis of DSA source images from acute anterior circulation stroke patients undergoing EVT.
  • Quantitative derivation of mean transit time (MTT) maps from post-EVT DSA using deconvolution.
  • Comparison of MTT values and Thrombolysis in Cerebral Infarction (TICI) grades in patients with and without 24-hour HT.
  • Receiver operating characteristic (ROC) modeling to determine the predictive accuracy of MTT for HT.

Main Results:

  • Perfusion maps were successfully generated from post-EVT DSA in 50 patients.
  • A U-shaped relationship was observed between post-EVT MTT and 24-hour HT.
  • MTT thresholds (<2 or >4 seconds) demonstrated high sensitivity (81%) and specificity (94%) for predicting HT.
  • Focal hyperperfusion or hypoperfusion on MTT maps corresponded to areas of subsequent HT.

Conclusions:

  • Quantitative perfusion assessment using DSA is feasible with minimal protocol modifications.
  • Post-recanalization perfusion imaging provides valuable prognostic information beyond visual angiographic assessment.
  • MTT derived from DSA can effectively predict the risk of hemorrhagic transformation after EVT.