Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, The Netherlands.
Transl Stroke Res. 2024 Feb;15(1):179-194. doi: 10.1007/s12975-022-01120-6. Epub 2023 Jan 19.
The goal of reperfusion therapy for acute ischemic stroke (AIS) is to restore cerebral blood flow through recanalization of the occluded vessel. Unfortunately, successful recanalization does not always result in favorable clinical outcome. Post-recanalization perfusion deficits (PRPDs), constituted by cerebral hypo- or hyperperfusion, may contribute to lagging patient recovery rates, but its clinical significance remains unclear. This scoping review provides an overview of clinical and preclinical findings on post-ischemic reperfusion, aiming to elucidate the pattern and consequences of PRPD from a translational perspective. The MEDLINE database was searched for quantitative clinical and preclinical studies of AIS reporting PRPD based on cerebral circulation parameters acquired by translational tomographic imaging methods. PRPD and stroke outcome were mapped on a charting table, creating an overview of PRPD after AIS. Twenty-two clinical and twenty-two preclinical studies were included. Post-recanalization hypoperfusion is rarely reported in clinical studies (4/22) but unequivocally associated with detrimental outcome. Post-recanalization hyperperfusion is more commonly reported (18/22 clinical studies) and may be associated with positive or negative outcome. PRPD has been replicated in animal studies, offering mechanistic insights into causes and consequences of PRPD and allowing delineation of possible courses of PRPD. Complex relationships exist between PRPD and stroke outcome. Diversity in methods and lack of standardized definitions in reperfusion studies complicate the characterization of reperfusion patterns. Recommendations are made to advance the understanding of PRPD mechanisms and to further disentangle the relation between PRPD and disease outcome.
急性缺血性脑卒中（AIS）再灌注治疗的目的是通过闭塞血管的再通恢复脑血流。不幸的是，成功的再通并不总是导致有利的临床结果。再灌注后灌注不足（PRPD），由脑低灌注或高灌注组成，可能导致患者恢复率滞后，但其临床意义仍不清楚。本范围综述提供了对缺血后再灌注的临床和临床前发现的概述，旨在从转化角度阐明 PRPD 的模式和后果。通过转化断层成像方法获取脑循环参数，对报道基于 PRPD 的 AIS 的定量临床和临床前研究进行了 MEDLINE 数据库搜索。在图表表上绘制了 PRPD 和中风结果，创建了 AIS 后 PRPD 的概述。共纳入 22 项临床研究和 22 项临床前研究。再灌注后低灌注在临床研究中很少报道（4/22），但与不良结果明确相关。再灌注后高灌注更为常见（18/22 项临床研究），可能与阳性或阴性结果相关。PRPD 已在动物研究中得到复制，为 PRPD 的原因和后果提供了机制见解，并允许描绘 PRPD 的可能过程。PRPD 与中风结果之间存在复杂的关系。再灌注研究中方法的多样性和缺乏标准化定义使再通模式的特征复杂化。提出了一些建议，以进一步了解 PRPD 机制，并进一步理清 PRPD 与疾病结果之间的关系。
