title: Intraprocedural parenchymal blood volume as a marker of reperfusion status in acute ischemic stroke intervention.
abstract: Parenchymal blood volume (PBV) mapping with flat panel detectors may provide real-time estimates of tissue perfusion during endovascular ischemic stroke procedures. We present two cases of acute middle cerebral artery (MCA) occlusion to demonstrate how PBV may: (1) be used in acute stroke; (2) influence intraprocedural decision-making; and (3) potentially serve as a predicator of clinical outcome. Both cases were successfully recanalized with endovascular embolectomy. Intraprocedural PBV maps were obtained immediately before and after recanalization. Pre-intervention reductions in PBV were seen throughout the MCA territory in both cases, with significant improvement in PBV in one case with good radiographic and clinical outcome and a lack of improvement in PBV in the second case with a large infarct volume. PBV deficit normalization may occur with recanalization of the parent artery and probably represents successful reperfusion. Baseline PBV maps should therefore be interpreted with caution and not interpreted to represent irreversible core infarct.
authors.affiliation: Semmes-Murphey Clinic, Memphis, Tennessee, USA.
authors.forename: Lucas
authors.initials: L
authors.lastname: Elijovich
authors.affiliation: Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
authors.forename: Vinodh T
authors.initials: VT
authors.lastname: Doss
authors.affiliation: Siemens Healthcare, Memphis, Tennessee, USA.
authors.forename: Heike
authors.initials: H
authors.lastname: Theessen
authors.affiliation: School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA.
authors.forename: Maheen
authors.initials: M
authors.lastname: Khan
authors.affiliation: Department of Neurosurgery, Semmes-Murphey Clinic/ University of TN, Memphis, Tennessee, USA.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Arthur
mesh_terms: D001810:Blood Volume / Q000502:physiology*; D002545:Brain Ischemia / Q000503:physiopathology* / Q000601:surgery*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000503:physiopathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D015424:Reperfusion; D020521:Stroke / Q000503:physiopathology* / Q000601:surgery*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Angiography; Artery; Embolic; Stroke