Skip to main content
AAN.com
Research Article
July 14, 2021
continuing medical education

Reversible Ischemic Lesion Hypodensity in Acute Stroke CT Following Endovascular Reperfusion

September 14, 2021 issue
97 (11) e1075-e1084
Letters to the Editor

Abstract

Background and Objectives

In acute stroke, early ischemic lesion hypodensity on CT is considered the imaging hallmark of brain infarction, representing a state of irreversible tissue damage with a continual increase of net water uptake. This dogma, however, is challenged by rare cases of apparently reversed early lesion hypodensity after complete reperfusion. The purpose of this study was to investigate the occurrence of reversible ischemic edema after endovascular treatment.

Methods

One hundred eighty-four patients with acute ischemic anterior circulation stroke were included after consecutive screening. Ischemic brain edema was determined with quantitative lesion net water uptake (NWU) in admission CT and follow-up CT based on CT densitometry, and ΔNWU was calculated as the difference. The association of edema progression to imaging and clinical parameters was investigated. Clinical outcome was assessed with the modified Rankin Scale (mRS) scores at day 90.

Results

Of 184 patients, 27 (14.7%) showed edema arrest and 3 (1.6%) exhibited significant edema reversibility. Higher degree of recanalization (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.46–6.01, p < 0.01) and shorter time from imaging to recanalization (OR per hour 0.32, 95% CI 0.18–0.54, p < 0.0001) were significantly associated with edema arrest or reversibility. Clinical outcome was significantly better in patients without edema progression (median mRS score 2 vs 5, p = 0.004).

Discussion

Although rare, lesion hypodensity considered to be representative of early infarct in acute stroke CT may be reversible after complete recanalization. Arrest of edema progression of acute brain infarct lesions may occur after successful rapid vessel recanalization, resulting in improved functional outcome. Future research is needed to investigate conditions in which early revascularization may halt or even reverse vasogenic edema of ischemic tissue.

Get full access to this article

View all available purchase options and get full access to this article.

References

1.
Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723-1731.
2.
Turc G, Bhogal P, Fischer U, et al. European Stroke Organisation (ESO)–European Society for Minimally Invasive Neurological Therapy (ESMINT) guidelines on mechanical thrombectomy in acute ischemic stroke. J Neurointerv Surg. 2019;11(6):535-538.
3.
Broocks G, Flottmann F, Hanning U, et al. Impact of endovascular recanalization on quantitative lesion water uptake in ischemic anterior circulation strokes. J Cereb Blood Flow Metab. 2020;40(2):437-445.
4.
Bardutzky J, Schwab S. Antiedema therapy in ischemic stroke. Stroke. 2007;38 (11):3084-3094.
5.
Schuier FJ, Hossmann KA. Experimental brain infarcts in cats, II: ischemic brain edema. Stroke. 1980;11(6):593-601.
6.
Unger E, Littlefield J, Gado M. Water content and water structure in CT and MR signal changes: possible influence in detection of early stroke. AJNR Am J Neuroradiol. 1988;9(4):687-691.
7.
Simard JM, Kent TA, Chen M, Tarasov KV, Gerzanich V. Brain oedema in focal ischaemia: molecular pathophysiology and theoretical implications. Lancet Neurol. 2007;6(3):258-268.
8.
Gotoh O, Asano T, Koide T, Takakura K. Ischemic brain edema following occlusion of the middle cerebral artery in the rat, I: the time courses of the brain water, sodium and potassium contents and blood-brain barrier permeability to 125I-albumin. Stroke. 1985;16(1):101-109.
9.
Todd NV, Picozzi P, Crockard A, Russell RW. Duration of ischemia influences the development and resolution of ischemic brain edema. Stroke. 1986;17(3):466-471.
10.
Kimberly WT, Dutra BG, Boers AMM, et al. Association of reperfusion with brain edema in patients with acute ischemic stroke: a secondary analysis of the MR CLEAN trial. JAMA Neurol. 2018;75(4):453-461.
11.
Dzialowski I, Klotz E, Goericke S, Doerfler A, Forsting M, von Kummer R. Ischemic brain tissue water content: CT monitoring during middle cerebral artery occlusion and reperfusion in rats. Radiology. 2007;243(3):720-726.
12.
Dzialowski I, Weber J, Doerfler A, Forsting M, von Kummer R. Brain tissue water uptake after middle cerebral artery occlusion assessed with CT. J Neuroimaging. 2004;14(1):42-48.
13.
Broocks G, Flottmann F, Scheibel A, et al. Quantitative lesion water uptake in acute stroke computed tomography is a predictor of malignant infarction. Stroke. 2018;49(8):1906-1912.
14.
Broocks G, Leischner H, Hanning U, et al. Lesion age imaging in acute stroke: water uptake in CT versus DWI-FLAIR mismatch. Ann Neurol. 2020;88(6):1144-1152.
15.
Barber PA, Demchuk AM, Zhang J, Buchan AM. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy: ASPECTS Study Group: Alberta Stroke Programme Early CT Score. Lancet. 2000;355(9216):1670-1674.
16.
Broocks G, Flottmann F, Ernst M, et al. Computed tomography-based imaging of voxel-wise lesion water uptake in ischemic brain: relationship between density and direct volumetry. Invest Radiol. 2018;53(4):207-213.
17.
Fiehler J. New ESO/ESMINT thrombectomy guidelines: after guideline writing is before guideline writing. Clin Neuroradiol. 2019;29(28):189-190.
18.
Yannes M, Frabizzio JV, Shah QA. Reversal of CT hypodensity after acute ischemic stroke. J Vasc Interv Neurol. 2013;6(1):10-14.
19.
Sheth KN, Petersen NH, Cheung K, et al. Long-term outcomes in patients aged </=70 years with intravenous glyburide from the phase II GAMES-RP study of large hemispheric infarction: an exploratory analysis. Stroke. 2018;49(6):1457-1463.
20.
Vorasayan P, Bevers MB, Beslow LA, et al. Intravenous glibenclamide reduces lesional water uptake in large hemispheric infarction. Stroke. 2019;50(11):3021-3027.
21.
Minnerup J, Broocks G, Kalkoffen J, et al. Computed tomography-based quantification of lesion water uptake identifies patients within 4.5 hours of stroke onset: a multicenter observational study. Ann Neurol. 2016;80(6):924-934.
22.
Nawabi J, Flottmann F, Hanning U, et al. Futile recanalization with poor clinical outcome is associated with increased edema volume after ischemic stroke. Invest Radiol. 2019;54(5):282-287.
23.
Broocks G, Hanning U, Flottmann F, et al. Clinical benefit of thrombectomy in stroke patients with low ASPECTS is mediated by oedema reduction. Brain. 2019;142(7):1399-1407.
24.
Salazar AJ, Useche N, Granja M, et al. Reliability and accuracy of individual Alberta Stroke Program Early CT Score regions using a medical and a smartphone reading system in a telestroke network. J Telemed Telecare. 2019.
25.
Kemmling A, Wersching H, Berger K, Knecht S, Groden C, Nölte I. Decomposing the Hounsfield unit: probabilistic segmentation of brain tissue in computed tomography. Clin Neuroradiol. 2012;22(1):79-91.
26.
Jindal G, Carvalho HP, Wessell A, et al. Beyond the first pass: revascularization remains critical in stroke thrombectomy. J Neurointerv Surg. 2019;11(11):1095-1099.
27.
Meyer L, Schonfeld M, Bechstein M, et al. Ischemic lesion water homeostasis after thrombectomy for large vessel occlusion stroke within the anterior circulation: the impact of age. J Cereb Blood Flow Metab. 2020;41(1):437-445.
28.
Ringer TM, Neumann-Haefelin T, Sobel RA, Moseley ME, Yenari MA. Reversal of early diffusion-weighted magnetic resonance imaging abnormalities does not necessarily reflect tissue salvage in experimental cerebral ischemia. Stroke. 2001;32(10):2362-2369.
29.
Boned S, Padroni M, Rubiera M, et al. Admission CT perfusion may overestimate initial infarct core: the ghost infarct core concept. J Neurointerv Surg. 2017;9(1):66-69.
30.
Bivard A, Kleinig T, Miteff F, et al. Ischemic core thresholds change with time to reperfusion: a case control study. Ann Neurol. 2017;82(6):995-1003.
31.
Fiehler J, Foth M, Kucinski T, et al. Severe ADC decreases do not predict irreversible tissue damage in humans. Stroke. 2002;33(1):79-86.
32.
Inoue M, Mlynash M, Christensen S, et al. Early diffusion-weighted imaging reversal after endovascular reperfusion is typically transient in patients imaged 3 to 6 hours after onset. Stroke. 2014;45(4):1024-1028.
33.
Schaefer PW, Mui K, Kamalian S, Nogueira RG, Gonzalez RG, Lev MH. Avoiding “pseudo-reversibility” of CT-CBV infarct core lesions in acute stroke patients after thrombolytic therapy: the need for algorithmically “delay-corrected” CT perfusion map postprocessing software. Stroke. 2009;40(8):2875-2878.
34.
Broocks G, Minnerup J, McDonough R, Flottmann F, Kemmling A. Letter by Broocks et al regarding article, “challenging the ischemic core concept in acute ischemic stroke imaging.” Stroke. 2021;52(2):e76–e77.
35.
Rotem SH, Mor S, Chen B, et al. Infarct core reliability by CT perfusion is a time-dependent phenomenon. J Neuroimaging. 2020;30(2):240-245.
36.
Goyal M, Ospel JM, Menon B, et al. Challenging the ischemic core concept in acute ischemic stroke imaging. Stroke. 2020;51(10):3147-3155.
37.
Tsang ACO, Lenck S, Hilditch C, et al. Automated CT perfusion imaging versus non-contrast CT for ischemic core assessment in large vessel occlusion. Clin Neuroradiol. 2020;30(1):109-114.
38.
von Kummer R, Bourquain H, Bastianello S, et al. Early prediction of irreversible brain damage after ischemic stroke at CT. Radiology. 2001;219(1):95-100.
39.
Zimmerman RD. Stroke wars: episode IV CT strikes back. AJNR Am J Neuroradiol. 2004;25(8):1304-1309.
40.
Dekeyzer S, Reich A, Othman AE, Wiesmann M, Nikoubashman O. Infarct fogging on immediate postinterventional CT: a not infrequent occurrence. Neuroradiology. 2017;59(9):853-859.
41.
Becker H, Desch H, Hacker H, Pencz A. CT fogging effect with ischemic cerebral infarcts. Neuroradiology. 1979;18(4):185-192.
42.
Skriver EB, Olsen TS. Transient disappearance of cerebral infarcts on CT scan, the so-called fogging effect. Neuroradiology. 1981;22(2):61-65.
43.
Broocks G, Kemmling A, Aberle J, et al. Elevated blood glucose is associated with aggravated brain edema in acute stroke. J Neurol. 2020;267(2):440-448.
44.
Broocks G, Kemmling A, Meyer L, et al. Computed tomography angiography collateral profile is directly linked to early edema progression rate in acute ischemic stroke. Stroke. 2019;50(12):3424-3430.

Information & Authors

Information

Published In

Neurology®
Volume 97Number 11September 14, 2021
Pages: e1075-e1084
PubMed: 34261783

Publication History

Received: March 23, 2021
Accepted: June 16, 2021
Published online: July 14, 2021
Published in print: September 14, 2021

Permissions

Request permissions for this article.

Disclosure

J. Fiehler reports the following: research support from the German Ministry of Science and Education, German Ministry of Economy and Innovation, German Research Foundation, European Union, Hamburgische Investitions- und Förderbank, Medtronic, Microvention, Route92, and Stryker; serving as a consultant for Acandis, Bayer, Boehringer Ingelheim, Cerenovus, Evasc Neurovascular, MD Clinicals, Medtronic, Microvention, Penumbra, Phenox, Stryker, and Transverse Medical; and being a stockholder in Tegus Medical. All other authors report no conflicts. Go to Neurology.org/N for full disclosures.

Study Funding

The authors report no targeted funding.

Authors

Affiliations & Disclosures

Gabriel Broocks, MD
From the Department of Diagnostic and Interventional Neuroradiology (G.B., R.M., L.M., M.B., H.K., M.T.N., J.F., U.H.), Institute of Medical Biometry and Epidemiology (G.S.), and Department of Neurology (E.B.), University Medical Center Hamburg-Eppendorf, Eppendorf, Germany; Department of Neuroradiology (P.S.), Universitaetsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (A.K.), University Hospital Schleswig-Holstein, Lübeck; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Rosalie McDonough, MD
From the Department of Diagnostic and Interventional Neuroradiology (G.B., R.M., L.M., M.B., H.K., M.T.N., J.F., U.H.), Institute of Medical Biometry and Epidemiology (G.S.), and Department of Neurology (E.B.), University Medical Center Hamburg-Eppendorf, Eppendorf, Germany; Department of Neuroradiology (P.S.), Universitaetsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (A.K.), University Hospital Schleswig-Holstein, Lübeck; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Lukas Meyer, MD
From the Department of Diagnostic and Interventional Neuroradiology (G.B., R.M., L.M., M.B., H.K., M.T.N., J.F., U.H.), Institute of Medical Biometry and Epidemiology (G.S.), and Department of Neurology (E.B.), University Medical Center Hamburg-Eppendorf, Eppendorf, Germany; Department of Neuroradiology (P.S.), Universitaetsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (A.K.), University Hospital Schleswig-Holstein, Lübeck; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Matthias Bechstein, MD
From the Department of Diagnostic and Interventional Neuroradiology (G.B., R.M., L.M., M.B., H.K., M.T.N., J.F., U.H.), Institute of Medical Biometry and Epidemiology (G.S.), and Department of Neurology (E.B.), University Medical Center Hamburg-Eppendorf, Eppendorf, Germany; Department of Neuroradiology (P.S.), Universitaetsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (A.K.), University Hospital Schleswig-Holstein, Lübeck; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Helge Kniep, DiplIng
From the Department of Diagnostic and Interventional Neuroradiology (G.B., R.M., L.M., M.B., H.K., M.T.N., J.F., U.H.), Institute of Medical Biometry and Epidemiology (G.S.), and Department of Neurology (E.B.), University Medical Center Hamburg-Eppendorf, Eppendorf, Germany; Department of Neuroradiology (P.S.), Universitaetsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (A.K.), University Hospital Schleswig-Holstein, Lübeck; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
(1) Eppdata GmbH, Management, 5 years
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Gerhard Schön, MSc
From the Department of Diagnostic and Interventional Neuroradiology (G.B., R.M., L.M., M.B., H.K., M.T.N., J.F., U.H.), Institute of Medical Biometry and Epidemiology (G.S.), and Department of Neurology (E.B.), University Medical Center Hamburg-Eppendorf, Eppendorf, Germany; Department of Neuroradiology (P.S.), Universitaetsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (A.K.), University Hospital Schleswig-Holstein, Lübeck; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Marie Teresa Nawka, MD
From the Department of Diagnostic and Interventional Neuroradiology (G.B., R.M., L.M., M.B., H.K., M.T.N., J.F., U.H.), Institute of Medical Biometry and Epidemiology (G.S.), and Department of Neurology (E.B.), University Medical Center Hamburg-Eppendorf, Eppendorf, Germany; Department of Neuroradiology (P.S.), Universitaetsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (A.K.), University Hospital Schleswig-Holstein, Lübeck; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
From the Department of Diagnostic and Interventional Neuroradiology (G.B., R.M., L.M., M.B., H.K., M.T.N., J.F., U.H.), Institute of Medical Biometry and Epidemiology (G.S.), and Department of Neurology (E.B.), University Medical Center Hamburg-Eppendorf, Eppendorf, Germany; Department of Neuroradiology (P.S.), Universitaetsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (A.K.), University Hospital Schleswig-Holstein, Lübeck; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany.
Disclosure
Scientific Advisory Boards:
1.
Acandis, Penumbra, Microvention, Stryker, Codman, Medtronic, Sequent
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
Honoraria and funding for travel from commercial companies Acandis, Penumbra, Microvention, Stryker, Codman, Medtronic, Sequent
Editorial Boards:
1.
Neuroradioloy, Section editor Interventional Neuroradiology 2008-2015, Clinical Neuroradiology 2015- today, JNIS 2019-today
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
CEO Eppdata
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
BMBF, BMWi, EU Stock/Stock Options, Medical Equipment & Materials: Tegus
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Uta Hanning, MD, MHBA
From the Department of Diagnostic and Interventional Neuroradiology (G.B., R.M., L.M., M.B., H.K., M.T.N., J.F., U.H.), Institute of Medical Biometry and Epidemiology (G.S.), and Department of Neurology (E.B.), University Medical Center Hamburg-Eppendorf, Eppendorf, Germany; Department of Neuroradiology (P.S.), Universitaetsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (A.K.), University Hospital Schleswig-Holstein, Lübeck; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Peter Sporns, MD, MHBA
From the Department of Diagnostic and Interventional Neuroradiology (G.B., R.M., L.M., M.B., H.K., M.T.N., J.F., U.H.), Institute of Medical Biometry and Epidemiology (G.S.), and Department of Neurology (E.B.), University Medical Center Hamburg-Eppendorf, Eppendorf, Germany; Department of Neuroradiology (P.S.), Universitaetsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (A.K.), University Hospital Schleswig-Holstein, Lübeck; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Ewgenia Barow, MD
From the Department of Diagnostic and Interventional Neuroradiology (G.B., R.M., L.M., M.B., H.K., M.T.N., J.F., U.H.), Institute of Medical Biometry and Epidemiology (G.S.), and Department of Neurology (E.B.), University Medical Center Hamburg-Eppendorf, Eppendorf, Germany; Department of Neuroradiology (P.S.), Universitaetsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (A.K.), University Hospital Schleswig-Holstein, Lübeck; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Jens Minnerup, MD
From the Department of Diagnostic and Interventional Neuroradiology (G.B., R.M., L.M., M.B., H.K., M.T.N., J.F., U.H.), Institute of Medical Biometry and Epidemiology (G.S.), and Department of Neurology (E.B.), University Medical Center Hamburg-Eppendorf, Eppendorf, Germany; Department of Neuroradiology (P.S.), Universitaetsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (A.K.), University Hospital Schleswig-Holstein, Lübeck; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
(1) Stroke, Editorial Board, since 2009, (2) Plos One, Academic Editor, since 2009
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
(1) Deutsche Forschungsgesellschaft, MI 1547/4-1, PI, since 2019 (2) Deutsche Forschungsgesellschaft, MI 1547/3-1, PI, since 2018
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Andre Kemmling, MD, MHBA
From the Department of Diagnostic and Interventional Neuroradiology (G.B., R.M., L.M., M.B., H.K., M.T.N., J.F., U.H.), Institute of Medical Biometry and Epidemiology (G.S.), and Department of Neurology (E.B.), University Medical Center Hamburg-Eppendorf, Eppendorf, Germany; Department of Neuroradiology (P.S.), Universitaetsspital Basel, Switzerland; Department of Neurology with Institute of Translational Neurology (J.M.), University Hospital Münster; Department of Neuroradiology (A.K.), University Hospital Schleswig-Holstein, Lübeck; and Department of Neuroradiology (A.K.), University Hospital Marburg, Germany.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
Phenox, Penumbra
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Correspondence Dr. Broocks [email protected]
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

Metrics & Citations

Metrics

Citations

Download Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Select your manager software from the list below and click Download.

Cited By
  1. Reversible CT Scan Hypodensity in Acute Ischemic Stroke Patient With Low Initial Alberta Stroke Program Early CT Score (ASPECTS) Following Endovascular Thrombectomy: A Case Report, Cureus, (2023).https://doi.org/10.7759/cureus.36194
    Crossref
  2. Net water uptake within the ischemic penumbra predicts the presence of the midline shift in patients with acute ischemic stroke, Frontiers in Neurology, 14, (2023).https://doi.org/10.3389/fneur.2023.1246775
    Crossref
  3. CT Perfusion Does Not Modify the Effect of Reperfusion in Patients with Acute Ischemic Stroke Undergoing Endovascular Treatment in the ESCAPE-NA1 Trial, American Journal of Neuroradiology, 44, 9, (1045-1049), (2023).https://doi.org/10.3174/ajnr.A7954
    Crossref
  4. Neuroimaging in Patient Selection for Thrombectomy, From the AJR Special Series on Emergency Radiology , American Journal of Roentgenology, 220, 5, (630-640), (2023).https://doi.org/10.2214/AJR.22.28608
    Crossref
  5. Association Between Net Water Uptake and Functional Outcome in Patients With Low ASPECTS Brain Lesions, Neurology, 100, 9, (e954-e963), (2023)./doi/10.1212/WNL.0000000000201601
    Abstract
  6. Recanalization status and temporal evolution of early ischemic changes following stroke thrombectomy, European Stroke Journal, (2023).https://doi.org/10.1177/23969873231214207
    Crossref
  7. Occult contrast retention post-thrombectomy on 24-h follow-up dual-energy CT: Associations and impact on imaging analysis, International Journal of Stroke, 18, 10, (1228-1237), (2023).https://doi.org/10.1177/17474930231182018
    Crossref
  8. Edema Reduction versus Penumbra Salvage: Investigating Treatment Effects of Mechanical Thrombectomy in Ischemic Stroke, Annals of Neurology, (2023).https://doi.org/10.1002/ana.26802
    Crossref
  9. The Benefit of Thrombectomy in Patients With Low ASPECTS Is a Matter of Shades of Gray—What Current Trials May Have Missed, Frontiers in Neurology, 12, (2022).https://doi.org/10.3389/fneur.2021.718046
    Crossref
  10. Apparent Reversal of Early Ischemic Changes on Non‐Contrast Computed Tomography Following Successful Endovascular Reperfusion, Stroke: Vascular and Interventional Neurology, 2, 4, (2022).https://doi.org/10.1161/SVIN.121.000197
    Crossref
  11. See more
Loading...

View Options

Get Access

Login options

Check if you have access through your login credentials or your institution to get full access on this article.

Personal login Institutional Login
Purchase Options

Purchase this article to get full access to it.

Purchase Access, $39 for 24hr of access

View options

Short Form

View Short Form

Full Text

View Full Text

Full Text HTML

View Full Text HTML

Media

Figures

Other

Tables

Share

Share

Share article link

Share