Serial Intracranial Flow Rate Measurements Using Quantitative Magnetic Resonance Angiography Following Large-Vessel...

Background/Objectives: Haemodynamic changes following ischaemic large-vessel occlusion (LVO) stroke might affect clinical outcome, including after endovascular recanalization. Using non-invasive quantitative MRA (qMRA), we report for the first time serial intracranial flow rate measurements following LVO and investigate flow rate changes, collateral pathway development, and their possible clinical significance. Methods: We report data from the prospective IMPreST study (Interplay of Microcirculation and Plasticity after Ischemic Stroke, registered at clinicaltrials.gov, no. NCT04035746). Patients with first-ever unilateral internal carotid artery (ICA) and/or M1/2 middle cerebral artery (MCA) occlusions were included. After being evaluated for gold-standard treatment, including endovascular thrombectomy, patients underwent early (<3 days) and late subacute (7 ± 3 days) qMRA flow measurements of the M1-MCA, A2-ACA (anterior cerebral artery), and P2-PCA (posterior cerebral artery) segments bilaterally. Results: Among 31 patients enrolled, 23 patients (17 recanalized, 6 non-recanalized) received both qMRA sessions. M1 volume flow rate (VFR) ratios (ischaemic/non-ischaemic hemisphere) in recanalized patients were symmetric (0.98-1.01) over time, while in non-recanalized patients M1 VFR ratios remained lower (0.74-0.77). P2 VFR ratios increased over time and were negatively correlated with M1 VFR ratios in late measurements (p = 0.016), possibly reflecting subacute activation of leptomeningeal collaterals via P2-PCA. In recanalized patients, lower M1 VFR ratios at 7 ± 3 days were significantly associated with a higher NIHSS at discharge after adjusting for infarct size, age, and NIHSS at admission (p = 0.02). Total hemispheric flow significantly decreased by up to 9% between early and late measurements in both the ischaemic and non-ischaemic hemispheres (p = 0.005). Conclusions: qMRA may help to understand flow status and collateral pathway activation after LVO stroke. Past the acute phase, low arterial flow to the affected region is associated with poorer neurological status, including after successful recanalization.