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Volume 16
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10.3390/brainsci16020171
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Article

Serial Intracranial Flow Rate Measurements Using Quantitative Magnetic Resonance Angiography Following Large-Vessel Occlusion Stroke

by
Jean-Philippe Dufour
1,
Corinne Inauen
2,
Lara Höbner
1,
Jacopo Bellomo
1,
Tilman Schubert
3,
Martina Sebök
1,
Jorn Fierstra
1,
Elisa Colombo
1,
Christiaan Hendrik Bas van Niftrik
1,
Marco Piccirelli
3,
Christoph Globas
2,
Zsolt Kulcsar
3,
Andreas Luft
2,
Susanne Wegener
2,
Luca Regli
1 and
Giuseppe Esposito
1,*
1
Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
2
Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
3
Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
*
Author to whom correspondence should be addressed.
Brain Sci. 2026, 16(2), 171; https://doi.org/10.3390/brainsci16020171
Submission received: 25 December 2025 / Revised: 23 January 2026 / Accepted: 28 January 2026 / Published: 31 January 2026
(This article belongs to the Section Neurosurgery and Neuroanatomy)
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Abstract

Background/Objectives: Haemodynamic changes following ischaemic large-vessel occlusion (LVO) stroke might affect clinical outcome, including after endovascular recanalization. Using non-invasive quantitative MRA (qMRA), we report for the first time serial intracranial flow rate measurements following LVO and investigate flow rate changes, collateral pathway development, and their possible clinical significance. Methods: We report data from the prospective IMPreST study (Interplay of Microcirculation and Plasticity after Ischemic Stroke, registered at clinicaltrials.gov, no. NCT04035746). Patients with first-ever unilateral internal carotid artery (ICA) and/or M1/2 middle cerebral artery (MCA) occlusions were included. After being evaluated for gold-standard treatment, including endovascular thrombectomy, patients underwent early (<3 days) and late subacute (7 ± 3 days) qMRA flow measurements of the M1-MCA, A2-ACA (anterior cerebral artery), and P2-PCA (posterior cerebral artery) segments bilaterally. Results: Among 31 patients enrolled, 23 patients (17 recanalized, 6 non-recanalized) received both qMRA sessions. M1 volume flow rate (VFR) ratios (ischaemic/non-ischaemic hemisphere) in recanalized patients were symmetric (0.98–1.01) over time, while in non-recanalized patients M1 VFR ratios remained lower (0.74–0.77). P2 VFR ratios increased over time and were negatively correlated with M1 VFR ratios in late measurements (p = 0.016), possibly reflecting subacute activation of leptomeningeal collaterals via P2-PCA. In recanalized patients, lower M1 VFR ratios at 7 ± 3 days were significantly associated with a higher NIHSS at discharge after adjusting for infarct size, age, and NIHSS at admission (p = 0.02). Total hemispheric flow significantly decreased by up to 9% between early and late measurements in both the ischaemic and non-ischaemic hemispheres (p = 0.005). Conclusions: qMRA may help to understand flow status and collateral pathway activation after LVO stroke. Past the acute phase, low arterial flow to the affected region is associated with poorer neurological status, including after successful recanalization.
Keywords: stroke; ischaemic stroke; magnetic resonance angiography; thrombectomy; cerebrovascular circulation; cerebrovascular disorders; haemodynamics stroke; ischaemic stroke; magnetic resonance angiography; thrombectomy; cerebrovascular circulation; cerebrovascular disorders; haemodynamics

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MDPI and ACS Style

Dufour, J.-P.; Inauen, C.; Höbner, L.; Bellomo, J.; Schubert, T.; Sebök, M.; Fierstra, J.; Colombo, E.; van Niftrik, C.H.B.; Piccirelli, M.; et al. Serial Intracranial Flow Rate Measurements Using Quantitative Magnetic Resonance Angiography Following Large-Vessel Occlusion Stroke. Brain Sci. 2026, 16, 171. https://doi.org/10.3390/brainsci16020171

AMA Style

Dufour J-P, Inauen C, Höbner L, Bellomo J, Schubert T, Sebök M, Fierstra J, Colombo E, van Niftrik CHB, Piccirelli M, et al. Serial Intracranial Flow Rate Measurements Using Quantitative Magnetic Resonance Angiography Following Large-Vessel Occlusion Stroke. Brain Sciences. 2026; 16(2):171. https://doi.org/10.3390/brainsci16020171

Chicago/Turabian Style

Dufour, Jean-Philippe, Corinne Inauen, Lara Höbner, Jacopo Bellomo, Tilman Schubert, Martina Sebök, Jorn Fierstra, Elisa Colombo, Christiaan Hendrik Bas van Niftrik, Marco Piccirelli, and et al. 2026. "Serial Intracranial Flow Rate Measurements Using Quantitative Magnetic Resonance Angiography Following Large-Vessel Occlusion Stroke" Brain Sciences 16, no. 2: 171. https://doi.org/10.3390/brainsci16020171

APA Style

Dufour, J.-P., Inauen, C., Höbner, L., Bellomo, J., Schubert, T., Sebök, M., Fierstra, J., Colombo, E., van Niftrik, C. H. B., Piccirelli, M., Globas, C., Kulcsar, Z., Luft, A., Wegener, S., Regli, L., & Esposito, G. (2026). Serial Intracranial Flow Rate Measurements Using Quantitative Magnetic Resonance Angiography Following Large-Vessel Occlusion Stroke. Brain Sciences, 16(2), 171. https://doi.org/10.3390/brainsci16020171

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