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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleNeurovascular/Stroke Imaging

Hyperperfusion and Blood-Brain Barrier Disruption beyond the Diffusion-Restricted Infarct 1 Day after Successful Mechanical Thrombectomy

Matthias A. Mutke, Arne Potreck, Markus A. Möhlenbruch, Sabine Heiland, Sibu Mundiyanapurath, Mirko Pham, Martin Bendszus and Angelika Hoffmann
American Journal of Neuroradiology May 2025, 46 (5) 908-914; DOI: https://doi.org/10.3174/ajnr.A8602
Matthias A. Mutke
aFrom the Department of Neuroradiology (M.A. Mutke, A.P., M.A. Möhlenbruch, S.H., M.B., A.H.), Heidelberg University Hospital, Heidelberg, Germany
bDivision of Neuroradiology (M.A. Mutke), Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
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Arne Potreck
aFrom the Department of Neuroradiology (M.A. Mutke, A.P., M.A. Möhlenbruch, S.H., M.B., A.H.), Heidelberg University Hospital, Heidelberg, Germany
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Markus A. Möhlenbruch
aFrom the Department of Neuroradiology (M.A. Mutke, A.P., M.A. Möhlenbruch, S.H., M.B., A.H.), Heidelberg University Hospital, Heidelberg, Germany
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Sabine Heiland
aFrom the Department of Neuroradiology (M.A. Mutke, A.P., M.A. Möhlenbruch, S.H., M.B., A.H.), Heidelberg University Hospital, Heidelberg, Germany
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Sibu Mundiyanapurath
cDepartment of Neurology (S.M.), Heidelberg University Hospital, Heidelberg, Germany
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Mirko Pham
dDepartment of Neuroradiology (M.P.), Würzburg University Hospital, Würzburg, Germany
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  • ORCID record for Mirko Pham
Martin Bendszus
aFrom the Department of Neuroradiology (M.A. Mutke, A.P., M.A. Möhlenbruch, S.H., M.B., A.H.), Heidelberg University Hospital, Heidelberg, Germany
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Angelika Hoffmann
aFrom the Department of Neuroradiology (M.A. Mutke, A.P., M.A. Möhlenbruch, S.H., M.B., A.H.), Heidelberg University Hospital, Heidelberg, Germany
eUniversity Institute of Diagnostic and Interventional Neuroradiology (A.H.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland.
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Abstract

BACKGROUND AND PURPOSE: Patterns of the cerebral microcirculatory response with changes in the BBB and perfusion in patients with stroke and a large vessel occlusion are still unclear. We combined dynamic contrast-enhanced (DCE) permeability and DSC perfusion MRI to detect such patterns beyond the borders of the diffusion-restricted infarct core after successful recanalization.

MATERIALS AND METHODS: Combined DCE permeability and DSC perfusion MRI were performed prospectively in patients within 24 hours after successful mechanical recanalization of acute MCA occlusion. Perfusion alterations were visually assessed on CBF and CBV maps; blood-brain barrier disruptions (BBBD), on Ktrans maps; and they were quantitatively evaluated with an ipsi- to contralateral ratio. Additionally, logistic regression analysis was performed for favorable early clinical outcome (NIHSS ≤2 at discharge).

RESULTS: Thirty-eight patients were included in the study. Subtle hyperperfusion beyond the DWI lesion was present in 13/38 patients (34%) on CBF-maps; and elevated CBV, in 15/38 patients (39%). In these patients, the ratios between ipsi- and contralateral white matter CBF (P = .01) and CBV (P < .01) were elevated compared with patients with normal readings. Subtle, but visually and quantitatively elevated Ktrans values outside the DWI-lesion were observed in 7/38 patients (18%). None of these perfusion alterations were related to clinical outcome.

CONCLUSIONS: Combined DCE permeability and DSC perfusion imaging is feasible in patients 24 hours after successful thrombectomy and reveals subtle hyperperfusion and BBBD occurring frequently beyond the diffusion-restricted infarct core.

ABBREVIATIONS:

BBBD
BBB disruption
DCE
dynamic contrast-enhanced
MT
mechanical thrombectomy
mTICI
modified TICI
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American Journal of Neuroradiology: 46 (5)
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Cite this article
Matthias A. Mutke, Arne Potreck, Markus A. Möhlenbruch, Sabine Heiland, Sibu Mundiyanapurath, Mirko Pham, Martin Bendszus, Angelika Hoffmann
Hyperperfusion and Blood-Brain Barrier Disruption beyond the Diffusion-Restricted Infarct 1 Day after Successful Mechanical Thrombectomy
American Journal of Neuroradiology May 2025, 46 (5) 908-914; DOI: 10.3174/ajnr.A8602

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Hyperperfusion and Blood-Brain Barrier Disruption beyond the Diffusion-Restricted Infarct 1 Day after Successful Mechanical Thrombectomy
Matthias A. Mutke, Arne Potreck, Markus A. Möhlenbruch, Sabine Heiland, Sibu Mundiyanapurath, Mirko Pham, Martin Bendszus, Angelika Hoffmann
American Journal of Neuroradiology May 2025, 46 (5) 908-914; DOI: 10.3174/ajnr.A8602
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