Ischemic core reversal on neuroimaging following endovascular reperfusion: A systematic review and meta-analysis
Year: 2026
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: Although the ischemic core is traditionally considered irreversibly injured, emerging evidence suggests it may be reversible on follow-up imaging, particularly after endovascular thrombectomy (EVT). We conducted a systematic review and meta-analysis to assess the prevalence, predictors, and outcomes of ischemic core reversal in acute ischemic stroke (AIS). We searched Medline, Embase, Scopus, and Web of Science through December 2024 for studies reporting core reversal after EVT. Fourteen studies (3640 patients) with baseline and follow-up imaging were included. A random-effects model was used to pool prevalence, associated factors, and outcomes. Core reversal occurred in 17.5% (95% CI: 11.9%-25.1%), more often in MR-based (19.9%) than CT-based (15.9%) studies, and at 24-48 h (19.1%) versus 48-168 h (12.3%). Predictors included shorter onset-to-baseline imaging time (median difference 90 min), IV thrombolysis (OR 1.41, 95% CI: 1.09-1.83), and successful recanalization (TICI 2B-3: OR 2.89, 95% CI: 1.65-5.06). Diabetes was associated with lower odds (OR 0.64, 95% CI: 0.47-0.86). Reversal correlated with better functional outcomes (mRS 0-2: OR 2.11, 95% CI: 1.55-2.86). Ischemic core reversal indicates that early imaging may overestimate infarct volume.
Institutions: King Faisal Specialist Hospital & Research Centre, Armed Forces Hospital Southern Region, Umm al-Qura University, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Alfaisal University, American University of Beirut Medical Center, American University of Beirut, King Saud University, Stanford Medicine, Stanford University, University of Alberta
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7124421761