Early Post-Thrombectomy MRI Markers

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BACKGROUND AND OBJECTIVES: A significant proportion of patients with ischemic stroke treated with endovascular therapy (EVT) do not achieve favorable clinical outcomes despite successful recanalization. Identifying patients who may benefit from adjunctive therapies is a priority. We hypothesized that incomplete reperfusion is associated with evolution of imaging markers on early post-EVT MRI and clinical outcome. METHODS: Patients who underwent attempted EVT for anterior circulation large vessel occlusion (LVO) stroke and had early (<6 hours) and planned 24-hour MRI were enrolled in the Guiding neUroprotection After Reperfusion to prevent Damage in acute ischemic Stroke study. Imaging markers were evaluated by consensus, blinded to clinical data except for the LVO target. Frequencies of imaging markers and lesion patterns, and their associations with reperfusion and clinical outcome were reported. Good clinical outcome was defined as modified Rankin Scale (mRS) score 0-2 at 30 days. RESULTS: = 0.015, 95% CI 1.24-7.33) remained a significant predictor of good clinical outcome at 30 days, even after adjusting for age, admission NIHSS score, and ENI. DISCUSSION: This observational study systematically characterized MRI markers at serial follow-up early after EVT. The heterogeneous and dynamic evolution observed during the hours and days after EVT in most patients suggests further opportunity to intervene, with early incomplete reperfusion and reperfusion injury as prognostic differentiators. Our findings can serve as a roadmap for designing future clinical trials to develop adjunctive therapies targeting these imaging markers.