Near-Complete Reversal of Large Diffusion-Weighted Imaging Lesion after Thrombectomy: A Case Report and Literature Review

Introduction:Diffusion-weighted imaging (DWI) plays a crucialrole in acute ischemic stroke (AIS), as it is used to evaluate theischemic lesions that are irreversibly damaged. The reversibilityof DWI ischemic lesions has been noted in patients with AIS whoundergo revascularization therapy. In addition, the occurrence ofthis phenomenon in large ischemic regions remains rare, par-ticularly the near-complete reversal of large DWI lesion cases.Case Presentation:A 58-year-old male presented with a gen-eralized tonic-clonic seizure. Emergent magnetic resonanceimaging (MRI) revealed an extremely large infarction lesion in theright hemisphere with an Alberta Stroke Program Early Com-puted Tomographic Score (ASPECTS) value of 2 and occlusion ofthe terminal right internal carotid artery. The patient was im-mediately transferred to the Digital Subtraction Angiography(DSA) Unit for endovascular treatment with a stent retriever.After a rapid successful reperfusion with expanded treatment incerebral infarction (eTICI) score of 3, the patient promptly re-covered 24 h after the procedure. A brain MRI was repeated after8 days of admission, and interestingly, the DWI lesion showedsignificant reversal. The modified Rankin scale (mRS) at dischargewas 2 and 1 at 90-day follow-up, respectively.Conclusions:Ourcase shows that the reversibility of DWI ischemic lesions canoccur during the acute stroke phase,eveninpatientswithextremely large regions, if rapid and successful reperfusion isachieved. The clinical implications of this phenomenon indicatethat using DWI to evaluate the infarct core should be interpretedwith caution.(c) 2024 The Author(s).Published by S. Karger AG, Basel