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Transient Ischemic Attack l: Introduction01:26

Transient Ischemic Attack l: Introduction

A transient ischemic attack (TIA) is a brief episode of neurological dysfunction caused by a temporary, focal reduction in cerebral blood flow. Although symptoms resemble those of an ischemic stroke, the interruption in perfusion is short-lived and does not cause permanent infarction. TIAs are clinically important because they often serve as early warning events for future stroke.Mechanisms of Transient Cerebral IschemiaTransient cerebral ischemia may arise through several mechanisms. One...

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Optimization of the Longa Middle Cerebral Artery Occlusion Method for Complete Reperfusion
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Angiographic Success Does Not Fully Reflect Tissue-Level Reperfusion: New Diffusion-Weighted Imaging Lesions After

Feyza Sönmez Topcu1, Arsida Bajrami2, Sena Aksoy2

  • 1Department of Radiology, Istanbul Aydin University, Medical Park Florya Hospital, 34295 Istanbul, Turkey.

Diagnostics (Basel, Switzerland)
|May 13, 2026
PubMed
Summary

New diffusion-weighted imaging (DWI) lesions are common after mechanical thrombectomy (MT) for acute ischemic stroke, even with complete reperfusion. These lesions, often small, do not impact short-term outcomes, suggesting limitations of angiographic endpoints.

Keywords:
diffusion-weighted imagingembolic strokemagnetic resonance imagingmechanical thrombectomyreperfusion

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Area of Science:

  • Neurology
  • Radiology
  • Cardiovascular Diseases

Background:

  • Complete angiographic reperfusion (TICI 3) is the goal of mechanical thrombectomy (MT) for acute ischemic stroke.
  • New diffusion-weighted imaging (DWI) lesions are often seen despite successful MT.

Purpose of the Study:

  • To determine the incidence, patterns, and clinical relevance of new DWI lesions in patients achieving TICI 3 reperfusion.
  • To assess the relationship between new DWI lesions and functional outcomes after MT.

Main Methods:

  • Retrospective analysis of 89 patients with anterior circulation large-vessel occlusion (LVO) who achieved TICI 3.
  • Comparison of baseline and follow-up MRI (DWI and ADC maps) within 48 hours to detect new lesions.
  • Evaluation of stroke etiology (TOAST) and 90-day functional outcomes (mRS).

Main Results:

  • New DWI lesions occurred in 31.5% of patients (28/89).
  • Lesions were mostly small cortical foci, ipsilateral to the recanalized vessel.
  • No significant difference in baseline characteristics or procedural metrics was found.
  • New DWI lesions were not associated with 90-day functional outcome or survival.

Conclusions:

  • New DWI lesions are frequent even after successful MT, indicating a gap between angiographic success and tissue perfusion.
  • These lesions are typically small and clinically insignificant in the short term.
  • Findings highlight the need for strategies beyond angiographic endpoints, focusing on microvascular protection and preventing distal embolization.