Influence of the site of arterial occlusion on multiple baseline hemodynamic MRI parameters and post-thrombolytic recanalization in acute stroke

• Published in: Neuroradiology Vol. 46; no. 11; pp. 883 - 887
• Main Authors: DEREX, L, HERMIER, M, ADELEINE, P, PIALAT, J. B, WIART, M, BERTHEZENE, Y, FROMENT, J. C, TROUILLAS, P, NIGHOGHOSSIAN, N
• Format: Journal Article
• Language: English
• Published: Berlin Springer 01.11.2004; Springer Nature B.V; Springer Verlag
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Blood vessels; Brain Ischemia - complications; Brain Ischemia - physiopathology; Carotid Stenosis - complications; Carotid Stenosis - diagnosis; Carotid Stenosis - drug therapy; Cerebrospinal fluid. Spinal cord. Spinal roots. Spinal nerves; Cerebrovascular Circulation - physiology; Electrodiagnosis. Electric activity recording; Female; Fibrinolytic Agents - therapeutic use; Humans; Intracranial Thrombosis - complications; Intracranial Thrombosis - diagnosis; Intracranial Thrombosis - drug therapy; Investigative techniques, diagnostic techniques (general aspects); Life Sciences; Magnetic Resonance Angiography; Male; Medical sciences; Middle Aged; Nervous system; Neurosurgery; NMR; Nuclear magnetic resonance; Other; Prospective Studies; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Stroke; Stroke - etiology; Stroke - physiopathology; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue Plasminogen Activator - therapeutic use; Treatment Outcome; Occlusion; Stroke; Nervous system diseases; Perfusion-weighted imaging; Radiodiagnosis; MRI; Acute stroke; Cardiovascular disease; Nuclear magnetic resonance imaging; Thrombolysis; Cerebral disorder; Vascular disease; Central nervous system disease; Hemodynamics; Cerebrovascular disease
• DOI: 10.1007/s00234-004-1279-y
• ISSN: 0028-3940

In this prospective MRI study, we evaluated the impact of the site of occlusion on multiple baseline perfusion parameters and subsequent recanalization in 49 stroke patients who were given intravenous tissue plasminogen activator (tPA). Pretreatment magnetic resonance angiography (MRA) revealed an arterial occlusion in 47 patients: (1) internal carotid artery (ICA) + M1 middle cerebral artery (MCA) occlusion (n=12); (2) M1 MCA occlusion (n=19); (3) M2 MCA, distal branches of the MCA and anterior cerebral artery (ACA) occlusion (n=16). Patients with ICA occlusion had significantly larger DWI, PWI and mismatch lesion volume on pretreatment MRI compared to patients with other sites of occlusion. The differences in cerebral blood flow (CBF) and peak height were significantly higher in patients with ICA occlusion compared to patients with other sites of occlusion (P=0.03 and P=0.04, respectively). Day 1 MRA showed recanalization in 28 patients (60%). The rate of recanalization was significantly different depending on the site of occlusion: 33% in ICA + M1 MCA occlusion, 63% in M1 MCA occlusion and 81% in either M2 MCA, distal branches of the MCA or ACA occlusion (P=0.002). Our data suggest that CBF and peak height are the most relevant MRI parameters to assess the severity of hemodynamic impairment in regard to the site of occlusion.