RT Journal Article
SR Electronic
T1 Microstructural Integrity of Salvaged Penumbra after Mechanical Thrombectomy
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 79
OP 85
DO 10.3174/ajnr.A6364
VO 41
IS 1
A1 M.T. Berndt
A1 C. Maegerlein
A1 T. Boeckh-Behrens
A1 S. Wunderlich
A1 C. Zimmer
A1 S. Wirth
A1 F.G. Mück
A1 S. Mönch
A1 B. Friedrich
A1 J. Kaesmacher
YR 2020
UL http://www.ajnr.org/content/41/1/79.abstract
AB BACKGROUND AND PURPOSE: There are sparse data on the microstructural integrity of salvaged penumbral tissue after mechanical thrombectomy of large-vessel occlusions. The aim of the study was to analyze possible microstructural alteration in the penumbra and their association with clinical symptoms as well as angiographic reperfusion success in patients undergoing mechanical thrombectomy.MATERIALS AND METHODS: All patients who underwent mechanical thrombectomy for large-vessel occlusions in the anterior circulation and who received an admission CT perfusion together with postinterventional DTIs were included (n = 65). Angiographic reperfusion success by means of modified Thrombolysis in Cerebral Infarction (mTICI) scale and clinical outcome were recorded. Microstructural integrity was assessed by DTI evaluating the mean diffusivity index within the salvaged gray matter of the former penumbra.RESULTS: The mean diffusivity index was higher in completely recanalized patients (mTICI 3: −0.001 ± 0.034 versus mTICI <3: −0.030 ± 0.055, P = .03). There was a positive correlation between the mean diffusivity index and NIHSS score improvement (r = 0.49, P = .003) and the mean diffusivity index was associated with midterm functional outcome (r = –0.37, P = .04) after adjustment for confounders. In mediation analysis, the mean diffusivity index and infarction growth mediated the association between reperfusion success and clinical outcomes.CONCLUSIONS: The macroscopic salvaged penumbra included areas of microstructural integrity changes, most likely related to the initial hypoperfusion. These abnormalities were found early after mechanical thrombectomy, were dependent on angiographic results, and correlated with the clinical outcome. When confirmed, these findings prompt the evaluation of therapies for protection of the penumbral tissue integrity.IQRinterquartile rangeLVOlarge-vessel occlusionMDmean diffusivityMTmechanical thrombectomySDstandard deviationmTICImodified Thrombolysis in Cerebral InfarctionmRSmodified Rankin ScaleNIHSSNational Institutes of Health Stroke Scale