Skip to Main content Skip to Navigation
Journal articles

Tissue no-reflow despite full recanalization following thrombectomy for anterior circulation stroke with proximal occlusion: A clinical study

Abstract : Despite early thrombectomy, a sizeable fraction of acute stroke patients with large vessel occlusion have poor outcome. The no-reflow phenomenon, i.e. impaired microvascular reperfusion despite complete recanalization, may contribute to such "futile recanalizations". Although well reported in animal models, no-reflow is still poorly characterized in man. From a large prospective thrombectomy database, we included all patients with intracranial proximal occlusion, complete recanalization (modified thrombolysis in cerebral infarction score 2c-3), and availability of both baseline and 24 h follow-up MRI including arterial spin labeling perfusion mapping. No-reflow was operationally defined as i) hypoperfusion ≥40% relative to contralateral homologous region, assessed with both visual (two independent investigators) and automatic image analysis, and ii) infarction on follow-up MRI. Thirty-three patients were eligible (median age: 70 years, NIHSS: 18, and stroke onset-to-recanalization delay: 208 min). The operational criteria were met in one patient only, consistently with the visual and automatic analyses. This patient recanalized 160 min after stroke onset and had excellent functional outcome. In our cohort of patients with complete and stable recanalization following thrombectomy for intracranial proximal occlusion, severe ipsilateral hypoperfusion on follow-up imaging associated with newly developed infarction was a rare occurrence. Thus, no-reflow may be infrequent in human stroke and may not substantially contribute to futile recanalizations.
Document type :
Journal articles
Complete list of metadatas

Cited literature [53 references]  Display  Hide  Download

https://www.hal.inserm.fr/inserm-02978221
Contributor : Clara Martinez Rico <>
Submitted on : Monday, October 26, 2020 - 11:58:51 AM
Last modification on : Tuesday, November 10, 2020 - 4:48:04 PM
Long-term archiving on: : Wednesday, January 27, 2021 - 6:42:57 PM

File

 Restricted access
To satisfy the distribution rights of the publisher, the document is embargoed until : 2021-03-20

Please log in to resquest access to the document

Identifiers

Citation

Adrien Ter Schiphorst, Sylvain Charron, Wagih Ben Hassen, Corentin Provost, Olivier Naggara, et al.. Tissue no-reflow despite full recanalization following thrombectomy for anterior circulation stroke with proximal occlusion: A clinical study. Journal of Cerebral Blood Flow and Metabolism, Nature Publishing Group, 2020, pp.271678X20954929. ⟨10.1177/0271678X20954929⟩. ⟨inserm-02978221⟩

Share

Metrics

Record views

58