Background Perfusion abnormalities after thrombolysis are frequent within and surrounding ischemic lesions, but their relative frequency is not well known.
Objective To describe the different patterns of perfusion abnormalities observed at 24 hours and compare the characteristics of the patients according to their perfusion pattern.
Methods From our thrombolysis registry, we included 226 consecutive patients with an available arterial spin labeling (ASL) perfusion sequence at day 1. We performed a blinded assessment of the perfusion status (hypoperfusion-h, hyperperfusion-H, or normal-N) in the ischemic lesion and in the surrounding tissue. We compared the time course of clinical recovery, the rate of arterial recanalization, and hemorrhagic transformations in the different perfusion profiles.
Results We identified seven different perfusion profiles at day 1. Four of these (h/h, h/H, H/H, and H/N) represented the majority of the population (84.1%). The H/H profile was the most frequent (34.5%) and associated with 3-month good outcome (modified Rankin Scale (mRS): 63.5%). Patients with persistent hypoperfusion within and outside the lesion (h/h, 12.4%) exhibited worse outcomes after treatment (mRS score 0–2: 23.8%) than other patients, were less frequently recanalized (40.7%), and had more parenchymal hematoma (17.8%). The h/H profile had an intermediate clinical trajectory between the h/h profile and the hyperperfused profiles.
Conclusion ASL hypoperfusion within the infarct and the surrounding tissue was associated with poor outcome. A more comprehensive view of the mechanisms in the hypoperfused surrounding tissue could help to design new therapeutic approaches during and after reperfusion therapies.
- MR perfusion
Data availability statement
No data are available. The data are not publicly available due to ethical restrictions.
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Contributors Substantial contributions to the conception or design of the work: CR, SB, YS, SL, or the acquisition, analysis: MA-S, AL, FB, FC, CR, SB or interpretation of data for the work: CR, SA, YS, SL, DD and drafting the work or revising it critically for important intellectual content: all; and final approval of the version to be published: all; and agreement to be accountable for all aspects of the work in fensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: all. CR acts as guarantor and accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.
Funding The research leading to these results has received funding from “Investissements d’avenir” ANR-10-IAIHU-06.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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