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Complete Restitution of the Ischemic Penumbra after Successful Thrombectomy

A Pilot Study Using Quantitative MRI

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Abstract

Purpose

Endovascular thrombectomy is highly effective in patients with proximal large artery occlusion but the relevance of reperfusion injury after recanalization is a matter of debate. The aim of this study was to investigate potential residual metabolic distress and microstructural tissue damage or edema after reperfusion using quantitative oxygen-sensitive T2′ and T2-mapping in patients successfully treated by thrombectomy.

Methods

Included in this study were 11 patients (mean age 70 ± 11.4 years) with acute ischemic stroke due to internal carotid artery and/or middle cerebral artery occlusion. Quantitative T2 and T2′ (1/T2′ = 1/T2* − 1/T2) were determined within the ischemic core and hypoperfused but salvaged tissue with delayed time-to-peak (TTP) in patients before and after successful thrombectomy and compared to a control region within the unaffected hemisphere.

Results

Decreased T2′ values within hypoperfused tissue before thrombectomy showed a normalization after recanalization (p < 0.01). In formerly hypoperfused but salvaged tissue, T2 values increased significantly after thrombectomy (p < 0.05) but did not differ from reference values in the control region. In salvaged tissue, increases of quantitative T2′ and T2 to follow-up were more pronounced in areas with severe TTP delay.

Conclusion

After successful recanalization, T2′ re-increased back to normal in formerly hypoperfused areas as a sign of prompt normalization of oxygen metabolism. Furthermore, quantitative T2 in the formerly hypoperfused tissue did not differ from reference values in unaffected tissue. These results indicate complete restitution of salvaged tissue after reperfusion and support the overall safety of endovascular thrombectomy with respect to microstructural tissue integrity.

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Author information

Authors and Affiliations

  1. Department of Neurology, Goethe University Frankfurt, Schleusenweg 2–16, 60528, Frankfurt am Main, Germany

    Alexander Seiler, Waltraud Pfeilschifter & Oliver C. Singer

  2. Institute of Neuroradiology, Goethe University Frankfurt, Frankfurt am Main, Germany

    Arne Lauer, Se-Jong You, Ulrich Pilatus & Marlies Wagner

  3. Brain Imaging Center, Goethe University Frankfurt, Frankfurt am Main, Germany

    Ralf Deichmann & Ulrike Nöth

Authors
  1. Alexander Seiler
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  2. Arne Lauer
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  3. Ralf Deichmann
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  4. Ulrike Nöth
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  5. Se-Jong You
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  6. Waltraud Pfeilschifter
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  7. Oliver C. Singer
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  9. Marlies Wagner
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Corresponding author

Correspondence to Alexander Seiler.

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Conflict of interest

A. Seiler is supported by a research grant from the Goethe University Frankfurt, Faculty of Medicine. W. Pfeilschifter has received research funding and travel reimbursement from Stryker Neurovascular. A. Lauer, R. Deichmann, U. Nöth, S.-J. You, O.C. Singer, U. Pilatus and M. Wagner declare that they have no competing interests.

Ethical standards

The study was approved by the local institutional review board and all patients gave written informed consent.

Additional information

A. Seiler and A. Lauer contributed equally to this work. U. Pilatus and M. Wagner contributed equally to this work.

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Seiler, A., Lauer, A., Deichmann, R. et al. Complete Restitution of the Ischemic Penumbra after Successful Thrombectomy. Clin Neuroradiol 29, 415–423 (2019). https://doi.org/10.1007/s00062-018-0675-3

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  • DOI: https://doi.org/10.1007/s00062-018-0675-3

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