Recanalization status and temporal evolution of early ischemic changes following stroke thrombectomy

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Computer tomography (CT) offers high resolution for detecting early ischemic changes (EIC) in acute ischemic stroke.
• Assessing temporal changes in EIC is crucial for understanding stroke progression and treatment efficacy.

Purpose of the Study:

• To evaluate the temporal evolution of EIC based on recanalization status after mechanical thrombectomy.
• To determine the impact of recanalization success on ASPECTS scores and lesion progression.

Main Methods:

• Retrospective analysis of 614 patients with anterior circulation ischemic stroke treated with thrombectomy.
• Classification of ischemic changes using Alberta Stroke Program Early CT Score (ASPECTS).
• Analysis of recanalization status using modified Thrombolysis in Cerebral Infarction (mTICI) and generalized linear mixed models.

Main Results:

• Median ASPECTS decreased from 9 at baseline to 7 at 24 hours.
• Successful recanalization (mTICI 3) was associated with more favorable ASPECTS changes compared to lower mTICI scores (p < 0.001).
• Recanalization effects were observed in cortical regions of ICA/M1 occlusions but not in deep structures or M2 occlusions. Baseline EIC persisted in all patients.

Conclusions:

• Temporal evolution of EIC and ASPECTS scores are linked to recanalization success in cortical areas of ICA/M1 occlusions.
• Recanalization therapy did not lead to the reversal of baseline EIC in any brain region.
• ASPECTS scores and EIC progression are influenced by recanalization success, particularly in cortical regions.