Fouzi Bala is an interventional neuroradiologist (MD, MSc) at Tours University Hospital. After his diagnostic and interventional neuroradiology training at Lille University Hospital, he did a research fellowship at the Kings College Hospital in London and then within the renowned Calgary Stroke Program. During his stay in Calgary, he led the imaging core lab of the randomized trial AcT and has been actively involved in the EVOLVE trial. His research interest focuses on thrombus imaging and the improvement of mechanical thrombectomy techniques.

Perfusion imaging Post Thrombectomy: What’s the evidence for no reflow?

The no-reflow phenomenon or impaired microvascular reperfusion despite successful reperfusion remains a significant challenge after endovascular treatment (EVT) of acute ischemic stroke. This phenomenon is associated with poor clinical outcomes and infarct growth despite the restoration of macrovascular blood flow (futile recanalization). Perfusion imaging plays a critical role in assessing tissue viability and microvascular integrity after EVT. Imaging biomarkers such as reduced cerebral blood volume/flow and prolonged Tmax may help detect no-reflow, reflecting microvascular obstruction, endothelial injury and inflammatory responses. However, challenges remain in standardizing imaging exams and interpreting perfusion imaging. Standardization of imaging protocols are needed to mitigate the impact of no-reflow and improve outcomes in stroke patients.