Endovascular thrombectomy in acute ischemic stroke shows ischemic core reversal in 17.5% of patients.

A systematic review and meta-analysis examined data from 3640 patients with acute ischemic stroke who underwent endovascular thrombectomy. The primary outcome assessed the prevalence of ischemic core reversal, defined as the reduction of infarct volume on follow-up imaging obtained 24 to 168 hours after the procedure.

The analysis found that ischemic core reversal occurred in 17.5% of the total population. Prevalence varied by imaging modality, with MR-based assessments showing a rate of 19.9% compared to 15.9% for CT-based assessments. Additionally, the prevalence was 19.1% when reversal was assessed within 24 to 48 hours, decreasing to 12.3% for assessments between 48 and 168 hours.

Predictors of reversal included shorter onset-to-baseline imaging time, with a median difference of 90 minutes associated with higher reversal rates. Functionally, ischemic core reversal correlated with better outcomes, specifically a favorable modified Rankin Scale score of 0 to 2, with an odds ratio of 2.11 (95% CI: 1.55-2.86). Other factors such as intravenous thrombolysis and TICI 2B-3 reperfusion were also associated with higher reversal rates.

Safety data, adverse events, and tolerability were not reported in the source data. The study limitations include the lack of reported absolute numbers for specific subgroups and the observational nature of the data, which precludes definitive causal conclusions. The practice relevance indicates that early imaging may overestimate the final infarct volume, suggesting a need for cautious interpretation of initial stroke volume assessments.