Long-Term Quantitative MRI and Quality-of-Life After Endovascular Therapy in Acute Ischemic Stroke - A MR CLEAN-NO IV Substudy.
Praneeta R Konduri, Dimitrios Karkalousos, Alexandra de Sitter et al.
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In 30 seconds
This long-term substudy of the MR CLEAN-NO IV randomised trial examined quantitative MRI and quality of life three years after acute ischaemic stroke. It included 24 patients who had 24-hour MRI and were functionally independent at 90 days. MRI showed focal volume loss, iron deposition, ventricular enlargement and myelin damage around the initial diffusion-weighted imaging lesion; basal ganglia changes were also evident. Hippocampal volume differences and iron deposition were moderately associated with quality of life. The findings describe persistent structural changes and associations with recovery in this selected group, rather than establishing treatment effects.
Key findings
- Among 24 participants, prominent peripheral myelin damage was observed at long-term MRI (BF:2.0⋅10 2), alongside focal volume loss, iron deposition and ventricular enlargement.
- Basal ganglia MRI showed very strong evidence of focal volume loss (BF > 8.1⋅10 2) and moderate to very strong evidence of iron deposition (BF: 5.0 to 2.7⋅10 2).
- Ipsilateral–contralateral hippocampal volume difference (BF:8.0) and iron deposition (BF:4.1) were moderately associated with quality of life.
- Higher systolic blood pressure was associated with reduced long-term ventricular atrophy (BF:5.8).
Why it matters
The findings indicate that structural changes can remain detectable years after stroke, including beyond the initial lesion and in the basal ganglia. Their associations with quality of life suggest that long-term recovery may relate to more than the visible acute infarct. Quantitative MRI may help characterise these changes, although this study does not establish that they cause differences in recovery.
What to keep in mind
The substudy included only 24 patients, selected for 90-day functional independence and availability of 24-hour MRI. Its observational analyses identify associations, not causal effects.