Wingspan stenting of symptomatic middle cerebral artery stenosis and perioperative evaluation using high-resolution 3 Tesla MRI

Mechanisms of Stroke After Intracranial Angioplasty and Stenting in the SAMMPRIS Trial

“…11 Potential approaches to reduce this risk of this phenomenon may include performing angioplasty alone rather than angioplasty and stenting 11 or using high-resolution MR vessel wall imaging for treatment planning or patient selection. 2, 12, 13 Even if the risk of perforator stroke after stenting could be reduced, aggressive risk factor management for patients with evidence of unstable or ruptured plaques adjacent to perforator-rich vessel segments may remain more effective than mechanical intervention.…”

Imaging Intracranial Vessel Wall Pathology With Magnetic Resonance Imaging

“…Most current intracranial vessel wall imaging methods therefore visualize only a relatively small portion of the intracranial arteries and focus on arteries at the level of the circle of Willis and just proximal to it. [10][11][12][14][15][16][17]21,40,44,45,49,50 Smaller distal intracranial arterial vessel walls are beyond the scope of these sequences. 42 However, a relatively low spatial resolution may well be sufficient to detect enhancement of a lesion or more generalized enhancement of the intracranial vasculature as a result of an increase in contrast-to-noise ratio caused by the contrast uptake (Table 1).…”

“…[10][11][12][13][14]21,[33][34][35]40,44,[45][46][47][48][49] Most of these lesions were first described in the posterior circulation (distal vertebral and basilar artery), [10][11][12]16,29,34,38 whereas more recent studies also showed these abnormalities in the middle cerebral arteries. [13][14][15]17,21,29,31,35,36,40,44,[45][46][47][48][49]57 In the last decade, 7 T MRI scanners have become available in a number of research centers and hospitals worldwide. With the even higher attainable SNR at 7 T, it became possible to perform isotropic vessel wall imaging with a larger coverage both in vivo 9 and ex vivo 53 (Table 1).…”

“…[11][12][13][14]17,20,21,29,31,[33][34][35]40,42,44,45,[47][48][49][50] With intracranial vessel wall imaging, multiple lesions in multiple segments often are detected that give a picture of the total burden of intracranial atherosclerosis. Detection and characterization of individual small intracranial vascular lesions may provide additional information (Figure 2).…”

Analysis of periinterventional complications of intracranial angioplasty and stenting: A single center experience

“…The risk of perforator strokes could possibly be reduced by careful patient selection. The presence of perforating arteries at the stenotic segment of the diseased vessel can be determined by angiography or high-resolution MRI before stenting and the presence of perforating arteries could be considered in the decision to perform the intervention [10]. In the SAMMPRIS trial, the presence of perforator arteries in the stenotic vessel was not assessed before intervention and perforator occlusion was the cause of the majority of periinterventional ischemic events [7].…”