7/3/2023 0 Comments Definition of eloquent cortex![]() ![]() Based on these neuroanatomical and functional concepts, we used a refined approach, aiming to assess the degree of reperfusion within the eloquent PMC in conjunction with the widely used volume-based reperfusion (TICI). 26 It is therefore logical to conclude that acute stroke treatments targeting reperfusion of the primary motor cortex (PMC) are likely to be the most significant determinant of functional outcome after EVT. Another oversimplified and widely utilized scale for measuring post-stroke disability is the modified Rankin Scale (mRS), which is largely based on motor function. 25 As such, more detailed angiographic assessment of reperfusion within the most eloquent cerebral vasculature supplying the motor cortex may optimize prediction of disability after EVT. Furthermore, as evidenced by exhaustive neurosurgical literature, identification of “eloquent” brain regions is a well-proven and long-established method for prediction of neurologic outcome after intracranial interventions. 18–24 These fundamental principles of vascular neurology may, in part, explain the reason why some patients with favorable mismatch profile remain disabled despite “successful” reperfusion. Multiple studies have demonstrated significant correlation between infarct location (particularly within motor pathways) and post-stroke disability, emphasizing the importance of corticospinal tract damage as a primary driver of functional motor recovery after stroke. 13–17 However, this volume-based reperfusion assessment undermines the complex functional organization of the human brain and does not take into consideration reperfusion of eloquent vascular territories, especially in patients who achieve incomplete/partial revascularization (TICI 2a or 2b). 12 Further iterations and expansions of this grading scale, adapted from the coronary circulation scoring system (TIMI) and applied to quantify cerebral reperfusion, consistently demonstrated incremental correlation between functional independence and higher volume of distal antegrade contrast flow on angiography. 8–11 Given the significant heterogeneity among these scales, an expert panel established TICI scoring as an optimal angiographic assessment of cerebral reperfusion therapies with successful recanalization defined as perfusion with >50% distal branch filling (TICI 2b). Since the inception of the first thrombectomy trials, various angiographic grading scales have been used for evaluation of the degree of ischemic tissue reperfusion, including arterial occlusive lesion (AOL), thrombolysis of myocardial ischemia (TIMI), and thrombolysis of cerebral ischemia (TICI). 1–7 The success of EVT relies on rapid and efficient reperfusion of the salvageable ischemic brain tissue after revascularization of the occluded vessel. Endovascular therapy (EVT) has emerged as a widely adopted and clinically proven treatment of acute ischemic stroke (AIS) due to anterior circulation large vessel occlusion (LVO) circulation. ![]()
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