Background and Purpose-Intraplaque hemorrhage (IPH) is associated with acute and future stroke. IPH is also associated with lumen markers of stroke risk including stenosis, plaque thickness, and ulceration. Whether IPH adds further predictive value to these other variables is unknown. The purpose of this study was to determine whether IPH improves carotid-source stroke prediction. Methods-In this retrospective cross-sectional study, patients undergoing stroke workup were imaged with MRI and IPH detection. Seven hundred twenty-six carotid-brain image pairs were analyzed after excluding vessels with noncarotid plaque stroke sources (420) and occlusions (7)

BACKGROUND AND PURPOSE: Arterial access is a technical consideration of mechanical thrombectomy that may affect procedural time, but few studies exist detailing the relationship of anatomy to procedural times and patient outcomes. We sought to investigate the respective impact of aortic arch and carotid artery anatomy on endovascular procedural times in patients with large-vessel occlusion. MATERIALS AND METHODS: We retrospectively reviewed imaging and medical records of 207 patients from 2 academic institutions who underwent mechanical thrombectomy for anterior circulation large-vessel occlusion from January 2015 to July 2018. Preintervention CTAs were assessed to measure features of the aortic arch and ipsilateral great vessel anatomy. These included the cranial-to-caudal distance from the origin of the innominate artery to the top of the aortic arch and the takeoff angle of the respective great vessel from the arch. mRS scores were calculated from rehabilitation and other outpatient documentation. We performed bootstrap, stepwise regressions to model groin puncture to reperfusion time and binary mRS outcomes (good outcome, mRS # 2). RESULTS: From our linear regression for groin puncture to reperfusion time, we found a significant association of the great vessel takeoff angle (P 4 .002) and caudal distance from the origin of the innominate artery to the top of the aortic arch (P 4 .05). Regression analysis for the binary mRS revealed a significant association with groin puncture to reperfusion time (P , .001). CONCLUSIONS: These results demonstrate that patients with larger takeoff angles and extreme aortic arches have an association with longer procedural times as approached from transfemoral access routes. ABBREVIATIONS: CCA 4 common carotid artery; CCIA 4 the cranial-to-caudal distance from the origin of the innominate artery to the top of the aortic arch; GPRT 4 groin puncture to reperfusion time; HTN 4 hypertension; LVO 4 large-vessel occlusion I schemic stroke is the fifth leading cause of death and the leading cause of long-term disability in the United States. 1 Recent studies have established mechanical thrombectomy as the criterion standard of care for large-vessel occlusion over tPA alone. 2-5 These and other studies have demonstrated that reduced time between the onset of symptoms and reperfusion leads to better clinical outcomes. 6,7 That time interval comprises prehospital

Background and Purpose: Cervical artery dissection is a major cause of ischemic stroke in the young and presents with various imaging findings including stenosis and intramural hematoma (IMH). Our goal was to determine the relative contribution of lumen findings and IMH to acute ischemic stroke, and if a heavily T1-weighted sequence could more reliably detect IMH. Methods: IRB approval was obtained for this retrospective study of 254 patients undergoing MRI/MRA for suspected dissection. Imaging included standard turbo spin echo (TSE) T1-fat saturation (T1FS) and heavily T1-weighted flow-suppressed Magnetization Prepared Rapid Acquisition Gradient-recalled Echo (MPRAGE) sequences. Subjects with stents (1) or atherosclerotic disease (26) were excluded, leaving 227 subjects. Kappa analysis was used to determine IMH interrater reliability on MPRAGE and T1FS in 4 vessels per subject. Lumen findings, cardiovascular risk factors, medications, and non-dissection stroke sources were recorded. Mixed effects multivariate Poisson regression was used to determine the prevalence ratio (PR) of each factor with acute ischemic stroke, accounting for 4 vessels per patient with backwards elimination to a threshold p-value of 0.10. Results: Patients were 41.9% male, mean age of 47.3±16.6 years, with 114 dissections and 107 strokes. IMH interrater reliability was significantly higher for MPRAGE (kappa=0.83, 95%CI: 0.78–0.86) versus T1FS (0.58, 95%CI: 0.57–0.68). The final acute stroke prediction model included MPRAGE-detected IMH (PR=2.0, 95%CI: 1.1–3.9, p=0.034), stenosis, pseudoaneurysm, male gender, current smoking, and non-dissection stroke sources. The final model had high discrimination for acute stroke (AUC=0.902, 95%CI: 0.872–0.932), compared to models without stenosis (0.861, 95%CI: 0.821–0.902), and without stenosis and IMH (0.831, 95%CI: 0.783–0.879). All three models were significantly different at p<0.05. Conclusions: Along with stenosis, IMH detection significantly contributed to acute ischemic stroke etiology in patients with suspected cervical artery dissection. In addition, IMH detection can be made more reliable with heavily T1-weighted sequences.