Background and purpose:
Recanalization reduces final infarct volume, an important predictor of clinical outcome. Lesion location is also a determinant of outcome, however, the extent to which recanalization affects lesion topography has yet to be explored. Are there brain regions more likely to be spared if recanalization occurs? We investigated this question by using voxel-based lesion mapping to examine the effect of recanalization on infarct topography in middle cerebral artery (MCA) occlusion.
Methods:
Consecutive patients with acute stroke from MCA occlusion were examined to identify brain regions characteristically spared with recanalization (R+) (TICI 2a to 3), but damaged in patients with persistent occlusions (R-). The lesions were drawn directly on the MRI or CT images and then transformed into stereotaxic space using MRIcroN software. Lesions were superimposed to create voxel-based lesion plots for each group. A leibemeister test was performed comparing the two groups at every brain voxel, with Bonferroni correction.
Results:
Twenty-one patients were included: 11 had endovascular recanalization (R+) and 10 received no or unsuccessful treatment (R-). The figure shows the lesion overlay plots and the statistical map resulting from the analysis. In total, 5,250,682 voxels were tested, yielding a Bonferroni corrected P <0.05 threshold of Z=5.6. No voxels were significantly more likely to be spared with recanalization. Mean stroke volumes were not significantly different (R-138cc, R+164 cc, P>0.1).
Conclusions:
Our analysis did not reveal brain regions characteristically spared with recanalization. Prior studies have shown reduced infarct volume after recanalization; ours did not, and this may be the underlying reason why no salvage pattern was observed. The effect of recanalization on stroke topography remains an important, unexplored area. We have shown that voxel-based lesion mapping has potential as a biomarker in endovascular therapy.
DEM Embedding in GNSS-Based Navigation Using a Statistical Modeling