Reperfusion Injury after Endovascular Stroke Treatment

Endovascular stroke treatment with mechanical thrombectomy (MT) has become the gold-standard treatment option of acute intracranial large vessel occlusion (LVO). Despite technically successful recanalization in up to 90%, 50% of all MT patients experience poor functional neurological outcome. The most serious MT-related complication contributing to poor prognosis is secondary intracranial hemorrhage (ICH) occurring in 20-25%, and is immediately symptomatic in 5-10% of cases. Post-recanalization hyperperfusion is an important risk factor/mechanism of thrombectomy-related ICH. In pilot studies, we identified bedside transcranial Duplex sonography (TCD) immediately after MT as a valuable screening tool for cerebral hyperperfusion predicting the later occurrence of ICH and reperfusion injury. There is an unmet need to identify risk factors for symptomatic ICH after endovascular stroke therapy as it is associated with poor outcome, no proven treatment strategies are available, and it delays or prohibits the use of anticoagulants / antithrombotics which would be necessary for early prevention of recurrent ischemic stroke.

In this prospective, longitudinal Austrian multicentre study, we want to explore the range and clinical impact of hemodynamic changes after MT as detected on bedside TCD and to assess whether patients with increased blood flow velocity in the recanalized middle cerebral artery (MCA) on TCD are at a higher risk to develop ICH / vasogenic brain edema (reperfusion injury) after MT