MRI Vessel Wall Imaging after Intra-Arterial Treatment for Acute Ischemic Stroke

Abstract

BACKGROUND AND PURPOSE: Vessel wall imaging is increasingly performed in the diagnostic work-up of patients with ischemic stroke. The aim of this study was to compare vessel wall enhancement after intra-arterial thrombosuction with that in patients not treated with thrombosuction. MATERIALS AND METHODS: From 2009 to 2017, forty-nine patients with an ischemic stroke underwent 7T MR imaging within 3 months after symptom onset as part of a prospective intracranial vessel wall imaging study. Fourteen of these patients underwent intra-arterial treatment using thrombosuction (intra-arterial treatment group). In the intra-arterial treatment group, vessel walls were evaluated for major vessel wall changes. All patients underwent pre-and postcontrast vessel wall imaging to assess enhancing foci of the vessel wall using coregistered subtraction images. A Wilcoxon signed rank test was performed to test for differences. RESULTS: In the intra-arterial treatment group, 11 of 14 patients (79%) showed vessel wall enhancement compared with 17 of 35 patients without intra-arterial treatment (49%). In the intra-arterial treatment group, more enhancing foci were detected on the ipsilateral side (n ¼ 18.5) compared with the contralateral side (n ¼ 3, P ¼ .005). Enhancement was more often concentric on the ipsilateral side (n ¼ 8) compared with contralateral side (n ¼ 0, P ¼ .01). No differences were found in the group without intraarterial treatment between the number and configuration of ipsilateral and contralateral enhancing foci. CONCLUSIONS: Patients with intra-arterial treatment by means of thrombosuction showed more (concentric) enhancing foci of the vessel wall ipsilateral compared with contralateral to the treated artery than the patients without intra-arterial treatment, suggesting reactive changes of the vessel wall. This finding should be taken into account when assessing vessel wall MR images in patients with stroke.

Unexplained early neurological deterioration after endovascular treatment for acute large vessel occlusion: incidence, predictors, and clinical impact: Data from ANGEL-ACT registry

“…This association seems biologically plausible, suggesting that: (1) EVT can cause damage to the vessel wall, including dissections, vessel wall edema, and rupture or damage to the endothelium that can potentially lead to recurrent thrombosis and distal embolism. More EVT attempts can aggravate the damage and increase the risk of END unexplained 29; and (2) more EVT attempts can prolong procedure duration, leading to expansion of the ischemic area even though the procedure duration was not the independent predictor of END unexplained in our model. Therefore, doctors should select optimal techniques, devices, and antiplatelet therapy to reduce the number of EVT attempts for achieving successful recanalization as soon as possible.…”

Practical Aspects of novel MRI Techniques in Neuroradiology: Part 2 – Acceleration Methods and Implications for Individual Regions

“…B. ca. 1 cm nach Duradurchtritt [59]) sowie Anreicherungen nach Thrombektomie [60] und vorwiegend exzentrisch bei intrakranieller Arteriosklerose [61] beobachtet werden können. In modifizierter Form eignen sich diese Sequenzen auch zur Detektion von Dissektionen [62][63][64][65][66] und könnten hier künftig aufwendigere Protokolle mit multiplen Einzelsequenzen ersetzen.…”

“…4b)), T1-weighted 3 D TSE sequences [59] should be used. It should be noted that because of the high sensitivity for vessel wall enhancement, physiological hyperintensities (e. g., approximately 1 cm after dural penetration [59]), as well as enhancement after thrombectomy [60] and predominantly eccentric in intracranial arteriosclerosis [61] can be observed. In modified form, these sequences are also suitable for the detection of dissections [62][63][64][65][66] and could replace more elaborate protocols with multiple single sequences in the future.…”

7T MRI for Intracranial Vessel Wall Lesions and Its Associated Neurological Disorders: A Systematic Review

“…Four 7T MRI studies used pre-and post-contrast vessel wall imaging to assess the characteristics of vessel wall atherosclerotic lesions (e.g., concentric or eccentric morphology and contrast enhancement) and their associated disorders. A study investigated the vessel wall enhancement after intra-arterial thrombosuction by using 7T MRI pre-and postcontrast 3D T1-weighted MPIR-TSE and TOF-MRA in patients with ischemic stroke and found patients with intra-arterial treatment had more concentric enhancing foci of the ipsilateral vessel wall, indicating the reactive changes in the vessel wall [17]. The enhancing vessel wall lesions were found to be corresponded with the number of cortical microinfarcts, suggesting the interrelationship between large vessel wall lesion burden and cerebral small vessel disease [18].…”