Deepa P. Bhupali, MD

Inoue M, Mlynash M, Christensen S, Wheeler HM, Straka M, Tipirneni A, et al. Early Diffusion-Weighted Imaging Reversal After EndovascularReperfusion Is Typically Transient in Patients Imaged 3 to 6 Hours AfterOnset. Stroke. 2014

Finding ways to improve patient outcomes with endovascular reperfusion therapy is a hot topic.  Inoue et al. examined the frequency and extent of early DWI lesion reversal following endovascular treatment.  Specifically, they looked at whether areas of reversal were sustained and they explored whether or not DWI lesion reversal positively impacted patient outcomes.  They found that early DWI reversibility is not unusual, but this reversal is not typically sustained.  Additionally, they did not find that this transient DWI reversal was associated with favorable clinical outcomes. 

The fact that DWI reversibility was not sustained can be interpreted as a set-back for the procedure – if tissue cannot be salvaged, is this procedure helpful?  But, in this study, it is important to note that the onset of symptoms to start of endovascular treatment was ~6 hours.  So maybe this speaks to a timing issue – perhaps if the procedure begins less than 6 hours after symptom onset, we might see an increase in the tissue that sustains DWI reversibility and this might translate into improved clinical outcomes.

Research and data have tempered the stroke world’s excitement for endovascular therapy.  Selecting the patients that would benefit from this procedure has been difficult.  This article speaks to the importance of timing.  Let’s start interventional reperfusion in less than 6 hours and in these cases, whether or not the DWI is reversible won’t be as important.