Valls Carbó A, Palomar A, Laredo C et al. Front Neurol. 2025 Feb 27;16:1478240. doi: 10.3389/fneur.2025.1478240. eCollection 2025. PMID: 40083459
https://pubmed.ncbi.nlm.nih.gov/40083459/
Background: Half of the patients who undergo successful recanalization after endovascular treatment (EVT) experience poor clinical outcomes. Impaired microvascular reperfusion (IMR) may explain this lack of improvement, but its frequency and clinical significance remain unclear. The study aims to describe the frequency and associated factors of IMR.
Materials and methods: We conducted a study on a cohort of patients with anterior large artery occlusion, treated with EVT at a single center, who achieved mTICI ≥2C. Perfusion MRI was obtained at arrival, up to 2 h after EVT (post-EVT MRI), and on day 5. IMR was observed only on the post-EVT relative cerebral blood volume (rCBV) maps as voxels within the follow-up ischemic lesion, exhibiting a > 15% asymmetry compared to a mirror homolog, in the absence of internal carotid occlusion, hemorrhagic transformation, or arterial reocclusion. Patients with an IMR volume greater than 5 mL were defined as having significant IMR. IMR was analyzed as a binary variable (presence/absence using the 5 mL cut-off) and by total and relative volume.
Results: IMR was present in 8 out of 33 patients (24.2%), with 4 out of 11 (36.4%) having mTICI 2C, and 4 out of 22 (18.2%) having mTICI 3. After adjustment for relevant variables, absolute and relative IMR volumes were associated with higher National Institutes of Health Stroke Scale (NIHSS) scores at 5 days (adjusted beta =0.50 [0.05, 0.96], p = 0.03) and at 24 h (adjusted beta = 0.11 [0.02, 0.19], p = 0.01). No independent associations were found between IMR and the 90-day modified Rankin Scale (mRS). Conclusion: IMR is present in one-quarter of patients and is associated with worse early neurological outcomes.
Funding: The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. The study was funded by project “PI21/01548”, Instituto de Salud Carlos III and co-funded by European Union (ERDF, “A way to make Europe” and project “RD21/0006/0024”, Instituto de Salud Carlos III and the Next Generation EU funds that finance the actions of the Recovery and Resilience Mechanism (MRR).