Introduction 1 2 3 4 5 4 6 7 2 8 9 Cerebral reperfusion injury: mechanisms and correlation with MRI Leukocyte infiltration and secondary ischemia as depicted with DW MRI 7 10 10 11 12 1 13 Fig. 1 MCAO control 13  13 2 14 15 16 15 Fig. 2 13  12 16 18 2 13 2 2 19 −6 2 20 −6 2 −6 2 21 Molecular mechanisms of leukocyte infiltration The mechanisms of leukocyte infiltration are characterized by leukocyte activation, leukocyte–endothelial interaction resulting in accumulation in the vascular bed, followed by leukocyte extravasation into the interstitial space. Each of these mechanisms is briefly reviewed. 22 27 27 11 1 28 31 31 2 1 27 32 Platelet-mediated reperfusion injury 33 35 36 37 38 P 33 33 Complement-mediated reperfusion injury 39 40 39 41 42 43 44 45 Postischemic hyperperfusion and PWI 1 46 47 46 47 48 48 49 Breakdown of the BBB and contrast-enhanced MRI 5 50 52 50 5 6 53 54 15 55 56 57 58 59 P P 60 Potential therapeutic strategies 61 64 11 12 65 66 65 67 68 69 70 69 70 Brain cooling 71 72 73 74 75 76 77 78 79 80 81 84 85 81 83 86 87 88 3 Fig. 3 P 88  Conditioned blood reperfusion 89 89 90 89 89 91 93 92 P Further studies are needed to evaluate the role of local hypothermia and conditioned blood perfusion in reducing postischemic reperfusion injury. It is possible, yet still speculative, that in the future interventional neuroradiologists may use these approaches following recanalization with thrombolytic agents or mechanical embolectomy to lessen reperfusion injury.