WSO - January 2024 - 63

Mujanovic et al.
63
Figure 1. Prevalence of no-reflow. Tmax: time to maximum; rCBF: relative cerebral blood flow; rCBV: relative cerebral blood
volume; MTT: mean transit time. One-third of stroke patients who achieved macrovascular reperfusion experienced the noreflow
phenomenon (29%, 95% CI, 21-37%). Prevalence of no-reflow was comparable between different subgroups that were
stratified by the perfusion imaging modality used to evaluate microvascular reperfusion, except when no-reflow was evaluated on
rCBF and rCBV perfusion maps (18%, 95% CI, 0-36%).
questions on the sensitivity of perfusion imaging to measure
small deficits on the microvascular level.
Time metrics in no-reflow
The Intervention-to-Follow-Up time also varied considerably
between studies.11,12,23 The percentage of patients with
no-reflow across different perfusion maps seems to numerically
decrease the longer the time since the intervention13,24-26;
however, that decrease was not significant in a
study-level meta-analysis. This seems consistent with the
findings of no-reflow in myocardial infarction cases.15
This decrease could suggest that transient events, such
as vasospasms or autolysis of small emboli, might be
responsible for the varying prevalence of microvascular
hypoperfusion over time.5 However, as this decrease was
mild, it could be hypothesized that more persisting intraand
perivascular events, such as pericyte disruption,
endothelial cell inflammatory response, or leukocyte and
neutrophil aggregation, are responsible for microvascular
hypoperfusion.6 True no-reflow rates might also be
partially masked by more common findings of hyper-,
rather than hypo-, perfusion after successful reperfusion
therapy.35 It would be difficult to determine whether microvascular
hypoperfusion occurred during or after the macrovascular
occlusion if perfusion imaging was not performed
immediately after the intervention.7 Therefore, the true
rates of no-reflow might be assessed most accurately when
tissue perfusion status is observed both immediately after
the intervention and again within the following 24 h, as all
of the aforementioned microvascular events are most likely
to occur within the 24-hour timeframe.5,6
Patients included for no-reflow assessment
Another factor that hinders the determination of true noreflow
rates is the choice of patients included in studies.
Earlier studies included only a small percentage of their
total study sample for no-reflow assessment, whereas
most recent studies included a larger percentage of their
cohort. This could partially be explained by changes in
scales and definitions of successful macrovascular
International Journal of Stroke, 19(1)

WSO - January 2024

Table of Contents for the Digital Edition of WSO - January 2024

Content
WSO - January 2024 - Cover1
WSO - January 2024 - Cover2
WSO - January 2024 - 1
WSO - January 2024 - Content
WSO - January 2024 - 3
WSO - January 2024 - 4
WSO - January 2024 - 5
WSO - January 2024 - 6
WSO - January 2024 - 7
WSO - January 2024 - 8
WSO - January 2024 - 9
WSO - January 2024 - 10
WSO - January 2024 - 11
WSO - January 2024 - 12
WSO - January 2024 - 13
WSO - January 2024 - 14
WSO - January 2024 - 15
WSO - January 2024 - 16
WSO - January 2024 - 17
WSO - January 2024 - 18
WSO - January 2024 - 19
WSO - January 2024 - 20
WSO - January 2024 - 21
WSO - January 2024 - 22
WSO - January 2024 - 23
WSO - January 2024 - 24
WSO - January 2024 - 25
WSO - January 2024 - 26
WSO - January 2024 - 27
WSO - January 2024 - 28
WSO - January 2024 - 29
WSO - January 2024 - 30
WSO - January 2024 - 31
WSO - January 2024 - 32
WSO - January 2024 - 33
WSO - January 2024 - 34
WSO - January 2024 - 35
WSO - January 2024 - 36
WSO - January 2024 - 37
WSO - January 2024 - 38
WSO - January 2024 - 39
WSO - January 2024 - 40
WSO - January 2024 - 41
WSO - January 2024 - 42
WSO - January 2024 - 43
WSO - January 2024 - 44
WSO - January 2024 - 45
WSO - January 2024 - 46
WSO - January 2024 - 47
WSO - January 2024 - 48
WSO - January 2024 - 49
WSO - January 2024 - 50
WSO - January 2024 - 51
WSO - January 2024 - 52
WSO - January 2024 - 53
WSO - January 2024 - 54
WSO - January 2024 - 55
WSO - January 2024 - 56
WSO - January 2024 - 57
WSO - January 2024 - 58
WSO - January 2024 - 59
WSO - January 2024 - 60
WSO - January 2024 - 61
WSO - January 2024 - 62
WSO - January 2024 - 63
WSO - January 2024 - 64
WSO - January 2024 - 65
WSO - January 2024 - 66
WSO - January 2024 - 67
WSO - January 2024 - 68
WSO - January 2024 - 69
WSO - January 2024 - 70
WSO - January 2024 - 71
WSO - January 2024 - 72
WSO - January 2024 - 73
WSO - January 2024 - 74
WSO - January 2024 - 75
WSO - January 2024 - 76
WSO - January 2024 - 77
WSO - January 2024 - 78
WSO - January 2024 - 79
WSO - January 2024 - 80
WSO - January 2024 - 81
WSO - January 2024 - 82
WSO - January 2024 - 83
WSO - January 2024 - 84
WSO - January 2024 - 85
WSO - January 2024 - 86
WSO - January 2024 - 87
WSO - January 2024 - 88
WSO - January 2024 - 89
WSO - January 2024 - 90
WSO - January 2024 - 91
WSO - January 2024 - 92
WSO - January 2024 - 93
WSO - January 2024 - 94
WSO - January 2024 - 95
WSO - January 2024 - 96
WSO - January 2024 - 97
WSO - January 2024 - 98
WSO - January 2024 - 99
WSO - January 2024 - 100
WSO - January 2024 - 101
WSO - January 2024 - 102
WSO - January 2024 - 103
WSO - January 2024 - 104
WSO - January 2024 - 105
WSO - January 2024 - 106
WSO - January 2024 - 107
WSO - January 2024 - 108
WSO - January 2024 - 109
WSO - January 2024 - 110
WSO - January 2024 - 111
WSO - January 2024 - 112
WSO - January 2024 - 113
WSO - January 2024 - 114
WSO - January 2024 - 115
WSO - January 2024 - 116
WSO - January 2024 - 117
WSO - January 2024 - 118
WSO - January 2024 - 119
WSO - January 2024 - 120
WSO - January 2024 - 121
WSO - January 2024 - 122
WSO - January 2024 - 123
WSO - January 2024 - 124
WSO - January 2024 - 125
WSO - January 2024 - 126
WSO - January 2024 - Cover3
WSO - January 2024 - Cover4
https://europe.nxtbook.com/nxteu/sageuk/wso_202404
https://europe.nxtbook.com/nxteu/sageuk/ukstrokeforum_202402_supp
https://europe.nxtbook.com/nxteu/sageuk/wso_202403
https://europe.nxtbook.com/nxteu/sageuk/wso_202402
https://europe.nxtbook.com/nxteu/sageuk/wso_202401
https://europe.nxtbook.com/nxteu/sageuk/wso_2023123_US_UKOnly
https://europe.nxtbook.com/nxteu/sageuk/wso_2023123_ROW
https://europe.nxtbook.com/nxteu/sageuk/wso_2023101
https://europe.nxtbook.com/nxteu/sageuk/wso_202308
https://europe.nxtbook.com/nxteu/sageuk/wso_202307
https://europe.nxtbook.com/nxteu/sageuk/wso_202306
https://europe.nxtbook.com/nxteu/sageuk/wso_202304
https://europe.nxtbook.com/nxteu/sageuk/wso_202303
https://europe.nxtbook.com/nxteu/sageuk/wso_202302
https://europe.nxtbook.com/nxteu/sageuk/wso_202301
https://www.nxtbookmedia.com