Resolution of MRI Imaging Findings of Stroke Following Mechanical Thrombectomy
Charles Love1, Michael Jacoby2
1Des Moines University, 2Department of Neurology, Mercy Medical Center
Background:
Mechanical thrombectomies are now the standard of care for large vessel occlusion strokes with signs of incomplete tissue loss. For successful outcomes, rapid intervention is essential due to the low ischemia tolerance of neural tissue, with death of neurons beginning within 5 minutes of cessation of blood flow. Even in cases of total clinical symptom resolution following acute stroke therapy, imaging findings indicative of recent stroke remain. There are no prior published report showing imaging resolution with a larger than 2.4mL initial perfusion deficit after tPA, and no published reports of imaging resolution following mechanical thrombectomy.
Design/Methods:
In this case series, we describe three occurrences of complete resolution of magnetic resonance imaging (MRI) findings of a large vessel stroke in patients who underwent successful mechanical thrombectomy (TICI-3) for a computed tomography angiography/perfusion (CTA/CTP) and angiographically confirmed thrombus-induced stroke.
Results:
In these patients, the initial perfusion deficit (Tmax >6 seconds) was between 35 and 61 ml. The time from symptom onset to full reperfusion was between 204- and 350-minutes post-symptom onset, which has traditionally been thought to be sufficient time to produce findings of permanent ischemic damage on MRI.
Conclusions:
Possible reasons for imaging resolution in these cases are related to the timing of the thrombectomy and the successfulness of reperfusion. Further research with a cohort or prospective study is warranted to identify differences in long-term prognostication for patients with imaging resolution compared to those who have an incomplete return to baseline imaging findings.