Perfusion Abnormalities on 24-Hour Perfusion Imaging in Patients With Complete Endovascular Reperfusion

Adnan Mujanovic ^1,2, Anick Imhof ¹, Shaokai Zheng ^1,3

⁰Department of Diagnostic and Interventional Neuroradiology (A.M., A.I., S.Z., E.I.P., B.L.S., T.D., A.H., R.W., J.G., J.K.), University of Bern, Switzerland.

Stroke +

|

August 15, 2024

View abstract on PubMed

Summary

Microvascular perfusion patterns impact stroke recovery. Hypoperfusion after reperfusion is linked to poor outcomes, while hyperperfusion may be beneficial in TICI3 stroke patients.

Area Of Science

Neuroscience
Radiology
Cardiovascular Medicine

Background

Perfusion abnormalities in infarct and penumbra areas may explain poor outcomes in TICI3 patients.
Microvascular perfusion patterns are increasingly recognized as crucial factors in stroke recovery.
Understanding these patterns is key to improving clinical outcomes after reperfusion therapy.

Purpose Of The Study

To identify distinct microvascular perfusion patterns in TICI3 patients.
To investigate the association between these patterns and clinical outcomes.
To stratify patients based on microvascular reperfusion status.

Main Methods

Analysis of stroke registry data from February 2015 to December 2021.
Grading macrovascular reperfusion using the Thrombolysis in Cerebral Infarction (TICI) scale.
Evaluating microvascular reperfusion (cerebral blood volume and flow) 24 hours postintervention.
Assessing functional independence (modified Rankin Scale 0-2) using logistic regression.

Main Results

Four microvascular perfusion clusters were identified: normoperfusion (n=143), hyperperfusion (n=54), hypoperfusion (n=14), and mixed (n=37).
Microvascular hypoperfusion was associated with significantly lower odds of functional independence (aOR 0.3).
Hyperperfusion showed a trend towards better functional outcomes (aOR 3.3).

Conclusions

Perfusion abnormalities on the microvascular level are present in about half of TICI3 patients.
Microvascular hypoperfusion, though rare, may contribute to poor outcomes despite successful macrovascular reperfusion.
A detrimental effect of hyperperfusion after reperfusion was not confirmed.

Keywords:

cerebrovascular circulation perfusion reperfusion stroke thrombolytic therapy