Use of Middle Cerebral Artery Visualization with Coronal Computed Tomography to Access Target Artery in Mechanical Thrombectomy

Ohya, Yuichiro; Uwatoko, Takeshi; Mizokami, Taichiro; Matsumoto, K.; Hashimoto, Go; Sugimori, Hiroshi

doi:10.1016/j.jstrokecerebrovasdis.2020.104714

Cited by 5 publications

(7 citation statements)

References 15 publications

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“…Several methods using CT or MRI have demonstrated occluded invisible cerebral vessels. 3,4 The advantage of CT is the shorter time and fewer contraindications such as presence of a pacemaker. On the other Additionally, thrombus size and length information obtained from 3D PDW-VISTA imaging helped to select the optimum size and length of the stent retriever, and correct placement of the stent retriever.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, the incidence of complications in EVT might be reduced by visualizing the cerebral vessels including the occluded invisible lesion. Several methods using CT or MRI have demonstrated occluded invisible cerebral vessels 3,4 . The advantage of CT is the shorter time and fewer contraindications such as presence of a pacemaker.…”

Section: Discussionmentioning

confidence: 99%

“…Several techniques using CT or T2-weighted (T2W) MRI have been evaluated for visualization of the invisible vessel course. 3,4 However, no standard method has been established yet.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, rapid and reliable information about the vessel course including the clot is important to reduce the risks and ensure the success of EVT. Several techniques using CT or T2‐weighted (T2W) MRI have been evaluated for visualization of the invisible vessel course 3,4 . However, no standard method has been established yet.…”

Section: Introductionmentioning

confidence: 99%

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Three‐dimensional vessel wall MRI to characterize thrombus prior to endovascular thrombectomy for large vessel occlusion stroke

Kumagai

Hayashi

Ueda

et al. 2022

Journal of Neuroimaging

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Background and Purpose Endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) caused by large vessel occlusion requires rapid and reliable imaging of the vessel course including the clot to reduce complications and ensure success. However, no method to acquire this information has been established. Methods Six consecutive patients with AIS caused by large vessel occlusion underwent EVT in our institute. High‐resolution vessel wall MRI was performed using three‐dimensional (3D) variable refocusing flip angle pulse and turbo spin‐echo sequences (VRFA‐TSE) with the volume isotropic turbo spin‐echo acquisition (VISTA) technique. This study evaluated the effectiveness of 3D proton density‐weighted (PDW) VRFA‐TSE (called PDW‐VISTA) compared with T2‐weighted (T2W) VRFA‐TSE (called T2W‐VISTA) to demonstrate the cerebral vessels including the occluded invisible lesion. Results PDW‐VISTA and T2W‐VISTA were successfully performed in all cases. PDW‐VISTA was more useful to visualize the anterior circulation than T2W‐VISTA by clearly revealing invisible vessels, whereas PDW‐VISTA and T2W‐VISTA had similar findings in the posterior circulation. The vessel courses shown by 3D PDW‐VISTA imaging before treatment and digital subtraction angiography after treatment showed good agreement in all cases. Furthermore, 3D PDW‐VISTA imaging demonstrated the length and size of the clot. Conclusions PDW‐VISTA imaging was found to more clearly depict the cerebral vessels including occluded lesion than T2W‐VISTA imaging. Findings of thrombus size and length were important for correctly placing the stent retriever and securing safety during the procedure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Several techniques using CT or T2-weighted (T2W) MRI have been evaluated for visualization of the invisible vessel course. 3,4 However, no standard method has been established yet.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Three‐dimensional vessel wall MRI to characterize thrombus prior to endovascular thrombectomy for large vessel occlusion stroke

Kumagai

Hayashi

Ueda

et al. 2022

Journal of Neuroimaging

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“…Coronal computed tomography (CT) image tracing reveals that the course of the middle cerebral artery (MCA) strongly aligns with intraoperative angiography. [ 18 ] Utilizing preoperative CT to map out surrounding vasculature informs surgical preplanning and may reduce the risk of vessel perforation. CTA-identified anatomical variations such as bovine aortic arch also correlate with transbronchial catheter insertion success for EVT.…”

Section: Current Horizons Of Endovascular Mechanical Thrombectomymentioning

confidence: 99%

Vascular tortuosity in endovascular mechanical thrombectomy

Farooq

Lee

2021

Brain Circulation

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Endovascular mechanical thrombectomy effectively removes occlusive thrombi from the arterial lumen; however, there is little literature supporting the relevance of vascular geometry on surgical outcomes. Critical vessel characteristics including the degree of angulation and tortuosity influence the ability to advance stent retriever devices toward the site of occlusion. Therefore, it is crucial to evaluate the impact of carotid artery catheter pathway accessibility on the thrombectomy outcomes in acute ischemic stroke (AIS) patients. Traditional imaging modalities generate incomplete pictures of the vascular tortuosity and are prone to clinical judgment errors. Recent three-dimensional computed tomography angiography image analysis techniques circumvent these limitations to calculate accurate tortuosity and angulation measurements. These novel images facilitate classifying common anatomical variant patients into groups that may be treated with specially designed catheter devices. Importantly, this image analysis method reveals significant angulation in the common carotid artery and extracranial internal carotid artery that correlates with delays in reaching the occlusion site. Increased age, which is associated with increased risk of stroke, also increases the incidence of severe tortuosity. The semi-automated measurements technique also demonstrate that full 360° arterial loops are present in nearly 3% of catheter pathways and that the overall degree of angulation differs bilaterally. In this review, we examine the utility of this novel image analysis procedure and evaluate the recent literature relevant to neuroendovascular thrombectomy in AIS patients. Three literature databases – PubMed, Embase, and Web of Science were queried for original articles investigating both preclinical and clinical thrombectomy applications.

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Evaluation of Middle Cerebral Artery Symmetry: A Pilot Study for Clinical Application in Mechanical Thrombectomy

et al. 2022

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Use of Middle Cerebral Artery Visualization with Coronal Computed Tomography to Access Target Artery in Mechanical Thrombectomy

Cited by 5 publications

References 15 publications

Three‐dimensional vessel wall MRI to characterize thrombus prior to endovascular thrombectomy for large vessel occlusion stroke

Three‐dimensional vessel wall MRI to characterize thrombus prior to endovascular thrombectomy for large vessel occlusion stroke

Vascular tortuosity in endovascular mechanical thrombectomy

Evaluation of Middle Cerebral Artery Symmetry: A Pilot Study for Clinical Application in Mechanical Thrombectomy

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