Early Post-Thrombectomy MRI Markers: Temporal Evolution and Association With Reperfusion and Clinical Outcome

Area of Science:

• Neurology
• Radiology
• Cardiovascular Medicine

Background:

• Many patients undergoing endovascular therapy (EVT) for ischemic stroke have poor outcomes despite successful reperfusion.
• Identifying patients who could benefit from additional treatments is crucial.

Purpose of the Study:

• To investigate the association between incomplete reperfusion, evolution of imaging markers on early post-EVT MRI, and clinical outcomes in acute ischemic stroke patients.

Main Methods:

• Prospective enrollment of patients with anterior circulation large vessel occlusion stroke undergoing EVT.
• Serial MRI including early (<6 hours) and 24-hour scans to evaluate imaging markers.
• Correlation of imaging findings with reperfusion status and 30-day clinical outcomes (modified Rankin Scale).

Main Results:

• Incomplete reperfusion (54%) was linked to larger lesion volumes, increased edema, and lesion growth on follow-up MRI.
• Early complete reperfusion correlated with lower NIHSS scores and improved early neurologic improvement.
• Absence of mixed signal on diffusion-weighted imaging (DWI) MRI was a significant predictor of good clinical outcome at 30 days.

Conclusions:

• MRI markers reveal dynamic changes after EVT, highlighting incomplete reperfusion and reperfusion injury as key prognostic factors.
• The observed heterogeneity in imaging evolution suggests potential for therapeutic intervention post-EVT.
• Findings provide a basis for designing future clinical trials focused on adjunctive therapies targeting specific imaging biomarkers.