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Updated: Aug 10, 2026
06:01
A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
Published on: August 18, 2015
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Progressive microvascular failure in acute ischemic stroke: A systematic review, meta-analysis, and time-course
Thilan Tudor1, Eleonora F Spinazzi1, Julia E Alexander1
1Department of Neurological Surgery, Columbia University Irving Medical Center, New York, NY, USA.
Summary
Microvascular failure occurs in 22% of acute ischemic stroke patients after successful revascularization. This rate approaches an asymptote of 28.5% within 6 hours of treatment, highlighting progressive microvascular dysfunction.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Interventional Radiology
Background:
- Microvascular failure is a critical complication in acute ischemic stroke (AIS) treatment.
- Endovascular therapy (EVT) and thrombolysis are standard treatments for AIS.
- Understanding the time course of microvascular failure is crucial for optimizing treatment strategies.
Purpose of the Study:
- To systematically review and meta-analyze the incidence of microvascular failure in AIS patients undergoing revascularization.
- To perform a novel time course analysis of microvascular failure using a curve-of-best-fit model.
- To investigate the impact of treatment time windows on microvascular failure rates.
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA-2020 guidelines.
- Searched Scopus and PubMed for studies on recanalization and reperfusion in AIS.
- Applied a negative exponential model for curve-of-best-fit analysis of microvascular failure rates.
Main Results:
- Included 27 studies with 1151 patients; 14 in standard (≤6h) and 13 in extended (>6h) time windows.
- Overall event rate of microvascular failure post-successful recanalization was 22% (95% CI: 16-30%).
- Microvascular failure rate approached an asymptote of 28.5% within the standard time window; the model did not converge for extended windows.
Conclusions:
- Progressive microvascular failure is increasingly recognized in AIS patients receiving revascularization.
- The time course analysis suggests a potential plateau in microvascular failure rates within the standard treatment window.
- Further research is needed to fully elucidate microvascular failure dynamics in extended time window treatments.
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