Longitudinal Evolution of Cerebral Metabolic Rate of Oxygen in Patients with Successfully Reperfused Ischemic Stroke
Year: 2026
Type: article
Study design: Observational Study
Abstract: ABSTRACT BACKGROUND AND PURPOSE: Cerebral Metabolic Rate of Oxygen (CMRO2) provides a direct measure of brain tissue metabolism and function, making it valuable in understanding physiological changes in infarct tissue in ischemic stroke patients. However, changes in cerebral metabolism and their significance in infarct tissue post-reperfusion remain underexplored. In this study, we examined the longitudinal changes in CMRO2 in infarct tissue in successfully reperfused ischemic stroke patients. MATERIALS AND METHODS: Fifty-one ischemic stroke patients with anterior circulation large vessel occlusion who underwent successful endovascular thrombectomy (EVT) were screened from a prospective longitudinal multicentre perspective study. MRI scans obtained at three post-EVT time points generated CBF and Oxygen Extraction Fraction (OEF) maps, from which CMRO2 maps were calculated. Mean CMRO2 values of manually delineated infarct ROIs and contralateral homologs were extracted and relative CMRO2 values (ratio of infarct and contralateral CMRO2 values) were analysed. The 3-month mRS scores were binarized into disabled (mRS > 1) and non-disabled (mRS ≤ 1), and relative CMRO2 was compared between the groups cross-sectionally and longitudinally. RESULTS: Relative CMRO2 values decreased significantly from 24-72 hours to 3 months (p < 0.001). Relative CMRO2 was significantly higher in the non-disabled patients than in the disabled patients at all time points, except at 24-72 hours. Longitudinal analysis in both non-disabled and disabled patients revealed a significant decrease in the relative CMRO2 values from 24-72 hours to 3 months (p < 0.001 for both). However, after 3 months, a visual but non-significant difference in CMRO2 trajectory was observed between the two groups. CONCLUSIONS: Post successful thrombectomy, relative cerebral metabolism in the infarct is elevated in the acute stage, before stabilizing over time. Patients with better functional outcomes consistently show better cerebral metabolism than patients with poor functional outcomes. ABBREVIATIONS: mTICI＝ modified TICI; OEF＝ Oxygen Extraction Fraction; CMRO2 = Cerebral Metabolic Rate of Oxygen; EVT = Endovascular Thrombectomy; PRAISE = Post-Reperfusion pathophysiology in Acute Ischemic StrokE; FSL = Functional MRI of the Brain Software Library; SD = Standard Deviation; IQR = Interquartile Range; ns = not statistically significant.
DOI: 10.3174/ajnr.a9165
Institutions: The University of Melbourne, The Royal Melbourne Hospital
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7124828187