Breaking with a dogma: persisting diffusion restrictions (pDWI) in follow-up after endovascular treatment for stroke.

Hernandez Petzsche, Moritz Roman; Boeckh-Behrens, Tobias; Bernkopf, Kathleen; Henze, Simone; Maegerlein, Christian; Sepp, Dominik; Zimmer, Claus; Wunderlich, Silke; Ikenberg, Benno; Berndt, Maria Teresa

doi:10.1136/jnis-2022-019678

journal article

Title:: Breaking with a dogma: persisting diffusion restrictions (pDWI) in follow-up after endovascular treatment for stroke.
Document type:: Journal Article
Author(s):: Hernandez Petzsche, Moritz Roman; Boeckh-Behrens, Tobias; Bernkopf, Kathleen; Henze, Simone; Maegerlein, Christian; Sepp, Dominik; Zimmer, Claus; Wunderlich, Silke; Ikenberg, Benno; Berndt, Maria Teresa
Abstract:: BACKGROUND: Post-stroke diffusion weighted imaging (DWI) signal transformation of the infarct core, which results in high apparent diffusion coefficient (ADC) values and variable DWI signal intensity, is completed no later than 1 month after onset of ischemia. We observed frequent exceptions to this timeline of change in DWI signal, which led to uncertainties in further clinical patient management. METHODS: A prospective single-center study of patients treated with mechanical thrombectomy of a large vessel occlusion in the anterior circulation was conducted. Patients received high-resolution MRI at 3T, including DWI, in the acute post-stroke phase and in the follow-up after 3-12 months. RESULTS: Overall, 78 patients (45 men) of mean age 63.6 years were evaluated. We identified persisting or new diffusion restriction in 29 of the 78 patients (37.2%) on follow-up imaging. Diffusion restrictions in a different location from the infarct core, representing new (sub-)acute ischemia, were observed in four patients (5.1%). Smaller areas of persisting diffusion restriction (pDWI lesions with high DWI signal and reduced ADC values) within the former infarct core were observed in 25 patients (32.1%) without clinical evidence of recurrent stroke, but with worse outcome scores at follow-up compared with patients without pDWI lesions. The presence of pDWI lesions is associated with a large primary infarct core (multivariate regression OR 1.03 (95% CI 1.01 to 1.05); p<0.01), mediating the relationship between pDWI lesions and clinical outcome. CONCLUSION: Smaller foci of persisting diffusion restriction (pDWI lesions) in the follow-up after endovascular treatment for stroke are frequent and likely represent a slowed ADC signal progression within a formerly large infarct core.
Journal title abbreviation:: J Neurointerv Surg
Year:: 2023
Journal volume:: 15
Journal issue:: 11
Pages contribution:: 1129-1135
Fulltext / DOI:: doi:10.1136/jnis-2022-019678
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/36539271
Print-ISSN:: 1759-8478
TUM Institution:: Klinik und Poliklinik für Neurologie (Prof. Hemmer); Professur für Neuroradiologie (Prof. Zimmer)
BibTeX