Long-Term Quantitative MRI and Quality-of-Life After Endovascular Therapy in Acute Ischemic Stroke - A MR CLEAN-NO IV...

This study aims to explore the long-term evolution of endovascular treatment after acute ischemic stroke (AIS) using quantitative MRI, and its relationship with quality of life (QoL). In this long-term substudy of patients from the MR CLEAN-NO IV trial, patients were included who received 24-hour post-stroke MRI and were functionally independent 90 days after stroke onset. Patients underwent a quantitative MRI exam three years after stroke onset to measure focal volume loss, myelin damage, iron deposition, and atrophy within and around the ischemic lesion seen on 24-hour-MRI, in addition to a QoL assessment. Bayesian statistical analyses were used to assess MRI measures lateralized to the ipsilateral hemisphere and to evaluate the relationship of these measures with baseline and treatment characteristics along with QoL. The Bayes Factor (BF) reflected moderate, strong or very strong evidence (BF = 3.0;20;1.5⋅10² respectively). In the 24 included patients, prominent focal volume loss, iron deposition, ventricular enlargement and myelin damage (BF:2.0⋅10²) were observed peripheral to the initial 24-hour DWI lesion at long-term FU MRI. In the basal ganglia nuclei, very strong evidence of focal volume loss (BF > 8.1⋅10²) and moderate to very strong evidence of iron deposition (BF: 5.0 to 2.7⋅10²) were observed at long-term assessment. Higher systolic blood pressure was associated with reduced long-term ventricular atrophy (BF:5.8). Long-term differences in ipsilateral versus contralateral hippocampal volume difference (BF:8.0) and iron deposition (BF:4.1) were moderately associated with QoL. Long-term subtle yet widespread demyelination and iron deposition were observed, and these changes correlated with long-term recovery.