Reperfusion Versus Recanalization: The Winner Is…

What a waste of writing. NO discussion at all of which one results in a lower neuronal cascade of death. Do these researchers not even know about this?
http://stroke.ahajournals.org/content/46/6/1433.full

1. Jenny P. Tsai, MDCM;
2. Gregory W. Albers, MD

+ Author Affiliations

1. From the Stanford Stroke Center, Department of Neurology, Stanford University Medical Center, Palo Alto, CA.

1. Correspondence to Jenny P. Tsai, MDCM, Stanford Stroke Center, Department of Neurology, Stanford University Medical Center, 780 Welch Rd, Suite 350, Palo Alto, CA 94304–5778. E-mail jptsai@stanford.edu

Key Words:

• Editorials
• perfusion imaging
• reperfusion

See related article, p 1582.

The terms reperfusion and recanalization are sometimes erroneously used interchangeably when referring to outcomes of thrombolytic or endovascular therapies. Recanalization and reperfusion are neither discrete nor static measures and although achieving one often implies the other has also occurred. Arterial obstructions and perfusion deficits can both evolve independently over time, in the early hours not only after stroke onset but also after therapeutic interventions. Distinguishing reperfusion from recanalization can be challenging in the clinical arena because currently available noninvasive measurements from multimodal computed tomography or magnetic resonance imaging (MRI) have imperfect sensitivity and specificity.

In this issue of Stroke, Cho et al¹ address the question of whether reperfusion or recanalization is a better predictor of a variety of outcomes in patients with acute stroke. The authors observed that successful recanalization consistently led to reperfusion of the ischemic territory; however, recanalization was not a prerequisite for reperfusion. Their data support the premise that reperfusion is the more influential of the 2 parameters on both clinical and radiological outcomes.

Cho et al analyzed a prospective database of patients with acute stroke studied with serial MR angiography, diffusion-weighted imaging (DWI), and bolus contrast perfusion imaging, on admission and 3 hours later. Forty-six patients were eligible for their study. The median volume of tissue at risk (perfusion lesion with T_max >6 seconds–DWI lesion) was 13 mL, which is modest compared with previous studies of patients with intracranial occlusions and likely reflects the predominance of more distal (M2 and M3) occlusions in the population studied. Recanalization that could be visualized on MR angiography (as measured by arterial occlusive lesion score) was present in 28% of the patients who reperfused. All patients who recanalized also reperfused. Reperfusion occurred in 59%; however, nearly a third of the patients with reperfusion did not have recanalization. Reperfusion status was positively associated with good clinical outcome, penumbral salvage, DWI lesion reversal, limited infarct growth, and final infarct volume. Associations between recanalization and favorable outcomes were less potent.