Department of Neurology, Medical University of South Carolina,USA.
Department of Radiology, University of Iowa Hospitals and Clinics,USA.
Neuroradiol J. 2021 Dec;34(6):593-599. doi: 10.1177/19714009211017782. Epub 2021 May 20.
High-resolution magnetic resonance imaging has the potential of characterising arterial wall changes after endovascular mechanical thrombectomy. The purpose of this study is to evaluate high-resolution magnetic resonance imaging features of large intracranial arteries following mechanical thrombectomy.
Patients who presented with acute ischaemic stroke due to large vessel occlusion and underwent mechanical thrombectomy were prospectively recruited. Subjects underwent high-resolution magnetic resonance imaging within 24 hours of the procedure. Magnetic resonance imaging sequences included whole brain T1 pre and post-contrast black-blood imaging, three-dimensional T2, contrast-enhanced magnetic resonance angiography and susceptibility-weighted imaging. Arterial wall enhancement was objectively assessed after normalisation with the pituitary stalk. The contrast ratio of target vessels was compared with non-affected reference vessels.
Twenty patients with 22 target vessels and 20 reference vessels were included in the study. Sixteen patients were treated with stentriever with or without aspiration, and four with contact aspiration only. Significantly higher arterial wall enhancement was identified on the target vessel when compared to the reference vessel (U = 22.5, < 0.01). The stentriever group had an 82% increase in the contrast ratio of the target vessel (x̄ = 0.75 ± 0.21) when compared to the reference vessel (x̄ = 0.41 ± 0.13), whereas the contact aspiration group had a 64% increase of the contrast ratio difference between target (x̄ = 0.62 ± 0.07) and reference vessels (x̄ = 0.38 ± 0.12). Approximately 65% of patients in the stentriever group had a positive parenchymal susceptibility-weighted imaging versus 25% in the contact aspiration group. There was no statistically significant correlation between susceptibility-weighted imaging volume and the percentage increase in the contrast ratio ( = 0.098, = 0.748).
This prospective pilot study used the objective quantification of arterial wall enhancement in determining arterial changes after mechanical thrombectomy. Preliminary data suggest that the use of stentrievers is associated with a higher enhancement as compared to reperfusion catheters.
高分辨率磁共振成像有可能对血管内机械血栓切除术后的动脉壁变化进行特征描述。本研究旨在评估机械血栓切除术后大颅内动脉的高分辨率磁共振成像特征。
前瞻性招募因大血管闭塞导致急性缺血性脑卒中并接受机械血栓切除的患者。患者在手术 24 小时内行高分辨率磁共振成像检查。磁共振成像序列包括全脑 T1 对比前、后黑血成像、三维 T2、对比增强磁共振血管造影和磁敏感加权成像。通过与垂体柄归一化来客观评估动脉壁增强。比较目标血管与未受影响的参考血管的对比率。
本研究纳入了 20 名患者的 22 个目标血管和 20 个参考血管。16 名患者接受支架取栓术治疗，其中 4 名患者联合抽吸，4 名患者仅采用接触抽吸。与参考血管相比，目标血管的动脉壁增强明显更高（U=22.5， < 0.01）。与参考血管（x̄=0.41 ± 0.13）相比，支架取栓组目标血管的对比率增加了 82%（x̄=0.75 ± 0.21），而接触抽吸组目标（x̄=0.62 ± 0.07）和参考血管（x̄=0.38 ± 0.12）之间的对比率差异增加了 64%。支架取栓组约有 65%的患者出现阳性实质磁敏感加权成像，而接触抽吸组仅为 25%。磁敏感加权成像体积与对比率增加百分比之间无统计学显著相关性（ = 0.098， = 0.748）。
本前瞻性初步研究使用动脉壁增强的客观定量来确定机械血栓切除术后的动脉变化。初步数据表明，与再通导管相比，支架取栓术与更高的增强相关。
