MR and CT Monitoring of Recanalization, Reperfusion, and Penumbra Salvage: Everything That Recanalizes Does Not Necessarily Reperfuse!

Revascularization therapies for acute stroke patients aim to rescue the ischemic penumbra by restoring the patency of the occluded artery (“recanalization”) and the downstream capillary blood flow (“reperfusion”). This article reviews the definition of recanalization and reperfusion used in stroke clinical trials and their limitations and proposes a study design to determine the relative importance of recanalization, reperfusion, and collateral flow in evaluating the efficacy of revascularization therapies for acute ischemic stroke.

[1]  M. Wintermark,et al.  Systematic comparison of perfusion‐CT and CT‐angiography in acute stroke patients , 2007, Annals of neurology.

[2]  R. Higashida,et al.  Intra-arterial Prourokinase for Acute Ischemic Stroke: The PROACT II Study: A Randomized Controlled Trial , 1999 .

[3]  A. Weill,et al.  North American clinical experience with the EKOS MicroLysUS infusion catheter for the treatment of embolic stroke. , 2003, AJNR. American journal of neuroradiology.

[4]  Scott Hamilton,et al.  Magnetic resonance imaging profiles predict clinical response to early reperfusion: The diffusion and perfusion imaging evaluation for understanding stroke evolution (DEFUSE) study , 2006, Annals of neurology.

[5]  S. Warach,et al.  The Desmoteplase in Acute Ischemic Stroke Trial (DIAS): A Phase II MRI-Based 9-Hour Window Acute Stroke Thrombolysis Trial With Intravenous Desmoteplase , 2005, Stroke.

[6]  M. Kowada,et al.  Cerebral ischemia. II. The no-reflow phenomenon. , 1968, The American journal of pathology.

[7]  A. Ames,et al.  NO REFLOW AFTER CEREBRAL ISCHÆMIA , 1967 .

[8]  R. Higashida,et al.  Trial Design and Reporting Standards for Intra-Arterial Cerebral Thrombolysis for Acute Ischemic Stroke , 2003, Stroke.

[9]  J. Broderick,et al.  Revascularization Results in the Interventional Management of Stroke II Trial , 2008, American Journal of Neuroradiology.

[10]  Ims Study Investigators.  Combined Intravenous and Intra-Arterial Recanalization for Acute Ischemic Stroke: The Interventional Management of Stroke Study , 2004, Stroke.

[11]  H. Lutsep,et al.  Mechanical Thrombectomy for Acute Ischemic Stroke: Final Results of the Multi MERCI Trial , 2008, Stroke.

[12]  M. Kern,et al.  The coronary no-reflow phenomenon: a review of mechanisms and therapies. , 2001, European heart journal.

[13]  T. Tomsick.  TIMI, TIBI, TICI: I came, I saw, I got confused. , 2007, AJNR. American journal of neuroradiology.

[14]  Keith Muir,et al.  Effects of alteplase beyond 3 h after stroke in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET): a placebo-controlled randomised trial , 2008, The Lancet Neurology.

[15]  Nancy J Fischbein,et al.  Regional Angiographic Grading System for Collateral Flow: Correlation With Cerebral Infarction in Patients With Middle Cerebral Artery Occlusion , 2004, Stroke.

[16]  Steven Warach,et al.  Dose Escalation of Desmoteplase for Acute Ischemic Stroke (DEDAS): Evidence of Safety and Efficacy 3 to 9 Hours After Stroke Onset , 2006, Stroke.

[17]  P. Akins,et al.  Intra-arterial prourokinase for acute ischemic stroke. , 2000, JAMA.

[18]  H. Lutsep,et al.  Safety and Efficacy of Mechanical Embolectomy in Acute Ischemic Stroke: Results of the MERCI Trial , 2005, Stroke.

[19]  H. S. Mueller,et al.  The Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I findings. , 1985, The New England journal of medicine.

[20]  A. Rebuzzi,et al.  The no-reflow phenomenon. , 2009, JACC. Cardiovascular imaging.