Relationships between brain perfusion and early recanalization after intravenous thrombolysis for acute stroke with large vessel occlusion

In large vessel occlusion (LVO) stroke, it is unclear whether severity of ischemia is involved in early post-thrombolysis recanalization over and above thrombus site and length. Here we assessed the relationships between perfusion parameters and early recanalization following intravenous thrombolysi...

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Bibliographic Details
Published in:Journal of cerebral blood flow and metabolism 2020-03, Vol.40 (3), p.667-677
Main Authors: Seners, Pierre, Turc, Guillaume, Lion, Stéphanie, Cottier, Jean-Philippe, Cho, Tae-Hee, Arquizan, Caroline, Bracard, Serge, Ozsancak, Canan, Legrand, Laurence, Naggara, Olivier, Debiais, Séverine, Berthezene, Yves, Costalat, Vincent, Richard, Sébastien, Magni, Christophe, Nighoghossian, Norbert, Narata, Ana-Paula, Dargazanli, Cyril, Gory, Benjamin, Mas, Jean-Louis, Oppenheim, Catherine, Baron, Jean-Claude
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Brain - blood supply
Brain - diagnostic imaging
Brain - physiopathology
Brain - surgery
Diffusion Magnetic Resonance Imaging
Female
Humans
Life Sciences
Magnetic Resonance Angiography
Male
Mechanical Thrombolysis
Middle Aged
Neurons and Cognition
Original
Perfusion
Prospective Studies
Registries
Retrospective Studies
Stroke - diagnostic imaging
Stroke - physiopathology
Stroke - surgery
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Summary:In large vessel occlusion (LVO) stroke, it is unclear whether severity of ischemia is involved in early post-thrombolysis recanalization over and above thrombus site and length. Here we assessed the relationships between perfusion parameters and early recanalization following intravenous thrombolysis administration in LVO patients. From a multicenter registry, we identified 218 thrombolysed LVO patients referred for thrombectomy with both (i) pre-thrombolysis MRI, including diffusion-weighted imaging (DWI), T2*-imaging, MR-angiography and dynamic susceptibility-contrast perfusion-weighted imaging (PWI); and (ii) evaluation of recanalization on first angiographic run or non-invasive imaging ≤ 3 h from thrombolysis start. Infarct core volume on DWI, PWI-DWI mismatch volume and hypoperfusion intensity ratio (HIR; defined as Tmax ≥ 10 s volume/ Tmax ≥ 6 s volume, low HIR indicating milder hypoperfusion) were determined using a commercially available software. Early recanalization occurred in 34 (16%) patients, and multivariable analysis was associated with lower HIR (P = 0.006), shorter thrombus on T2*-imaging (P 
ISSN:0271-678X
1559-7016
DOI:10.1177/0271678X19836288