Quantitative MR Perfusion Imaging Post-Endovascular Therapy: Defining Reperfusion Biomarkers In Acute Ischemic Stroke

Nabin Kumar Yadav; Bijay Kumar Yadav; Bhawesh Kumar Yadav; Birendra Kumar Yadav

doi:10.36948/ijfmr.2025.v07i04.49175

Quantitative MR Perfusion Imaging Post-Endovascular Therapy: Defining Reperfusion Biomarkers In Acute Ischemic Stroke

Author(s)	Dr. Nabin Kumar Yadav, Dr. Bijay Kumar Yadav, Dr. Bhawesh Kumar Yadav, Mr. Birendra Kumar Yadav
Country	India
Abstract	Quantitative MR perfusion imaging has emerged as a critical tool in evaluating tissue-level reperfusion following endovascular therapy (EVT) for acute ischemic stroke (AIS). While angiographic recanalization signifies macrovascular success, it often fails to capture microvascular dynamics that influence clinical outcomes. This review comprehensively explores the utility of MR perfusion techniques—including dynamic susceptibility contrast (DSC) and arterial spin labeling (ASL)—to assess key hemodynamic parameters such as cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP), and Tmax. Post-EVT imaging frequently reveals phenomena like impaired microvascular reperfusion (IMR) or “no-reflow,” even in patients with complete angiographic reperfusion (TICI 3), and these conditions have been strongly linked to infarct progression, hemorrhagic transformation, and worse functional outcomes. Conversely, hyperperfusion patterns may indicate either successful tissue salvage or an ominous sign of blood-brain barrier disruption, depending on extent and context. Recent studies underscore the prognostic value of perfusion biomarkers in stratifying post-EVT patients and guiding blood pressure management, ICU monitoring, and rehabilitation planning. However, variability in imaging protocols, thresholds (e.g., relative CBF, Tmax >6s), and timing limits generalizability. This review highlights the need for standardized definitions and imaging workflows, while reinforcing the translational potential of MR perfusion imaging in enhancing personalized post-stroke care and advancing future clinical trials focused on microvascular targets.
Keywords	Acute Ischemic Stroke, Endovascular Therapy (EVT), Magnetic Resonance Perfusion Imaging, Dynamic Susceptibility Contrast (DSC), Arterial Spin Labeling (ASL), Cerebral Blood Flow (CBF), Cerebral Blood Volume (CBV), Mean Transit Time (MTT), Time to Peak (TTP), Tmax, No-Reflow Phenomenon, Impaired Microvascular Reperfusion (IMR), Post-Stroke Hyperperfusion, Perfusion Biomarkers, Stroke Prognostication, Tissue Reperfusion, Functional Outcome Prediction, Microvascular Perfusion, Neuroimaging in Stroke, Reperfusion Injury
Field	Medical / Pharmacy
Published In	Volume 7, Issue 4, July-August 2025
Published On	2025-07-16
DOI	https://doi.org/10.36948/ijfmr.2025.v07i04.49175
Short DOI	https://doi.org/g9tz3n

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Quantitative MR Perfusion Imaging Post-Endovascular Therapy: Defining Reperfusion Biomarkers In Acute Ischemic Stroke

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