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Lee J, Lee HJ, Ha SY, Kim HC, Kang Y, Jin SC, Park S. Assessment of thrombus using susceptibility-weighted filtered-phase images in patients with acute ischemic stroke. J Neuroimaging 2023; 33:147-155. [PMID: 36068702 DOI: 10.1111/jon.13047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND AND PURPOSE Recognizing the location and length of the thrombus responsible for large vessel occlusion in patients with acute ischemic stroke can facilitate effective endovascular recanalization therapy (ERT). We hypothesized that the aliasing or dipole effect produced by filtered-phase susceptibility-weighted imaging (SWI) would facilitate thrombus delineation. METHODS Of the patients with middle cerebral artery occlusion who underwent ERT, we screened those who underwent noncontrast CT (NCCT), multiphase CT angiography (mCTA), and SWI before the endovascular procedure. We used an arbitrary index termed measurement of equivalence in thrombus assessed by digital subtraction angiography (METAD) defined as having the same location as the thrombus observed in the digital subtraction angiography (DSA) and length differing by less than 5 mm. For NCCT, mCTA, SWI_m (magnitude), and SWI_p (phase), the length of the thrombus and METAD were assessed. RESULTS The mean lengths of the thrombi determined using NCCT, mCTA, SWI_m, SWI_p, and DSA were 14.03, 13.47, 13.89, 9.93, and 8.96 mm, respectively. The absolute agreement for thrombus length was excellent for SWI_p and DSA (intraclass correlation coefficient [ICC] = .96), moderate for SWI_m and DSA (ICC = .53), and poor for mCTA and DSA (ICC = .14). The METADs were 26.7%, 40.0%, 33.3%, and 73.3% for NCCT, mCTA, SWI_m, and SWI_p, respectively. The METADs for NCCT and SWI_p were significantly different (p = .045) and those for mCTA and SWI_m were not (p = .537 and .093, respectively). CONCLUSIONS The SWI_p was best matched with the DSA for the measurement of the lengths and locations of thrombi. The use of pre-thrombectomy SWI_p imaging for acute ischemic stroke may facilitate a successful ERT strategy.
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Affiliation(s)
- Joonwon Lee
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Ho-Joon Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Sam Yeol Ha
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Hyung Chan Kim
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Yeonah Kang
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Sung-Chul Jin
- Department of Neurosurgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Seongho Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
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Pressman E, Sommer KN, Waqas M, Siddiqui AH, Ionita CN, Mokin M. Comparison of stent retriever thrombectomy using 3-dimensional patient-specific models of intracranial circulation with actual middle cerebral artery occlusion thrombectomy cases. J Neuroimaging 2022; 32:436-441. [PMID: 34958701 PMCID: PMC9899120 DOI: 10.1111/jon.12961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/05/2021] [Accepted: 12/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND PURPOSE Stent retriever (SR) thrombectomy is commonly used for the treatment of emergent large vessel occlusion (ELVO) in acute ischemic stroke. Clot imaging parameters such as clot length, diameter, distance to the internal carotid artery terminus, and vessel angle where the SR is deployed may predict the likelihood of achieving first pass effect (FPE). Most of the proposed factors that seem to affect recanalization success have been studied individually, and conflicting data derived from clinical versus in vitro studies using 3-dimensional printed models of intracranial circulation currently exist. METHODS Using patient-specific 3-dimensional phantoms of the cervical and intracranial circulation, we simulated middle cerebral arteries (MCA) M1 and M2 occlusions treated with SR thrombectomy using Solitaire (Medtronic) or Trevo (Styker). Our primary outcome was FPE, defined as Thrombolysis in Cerebral Infarction score of 2c-3 achieved after a single thrombectomy attempt. We also performed retrospective analysis of same clot imaging characteristics of consecutive cases of MCA occlusion and its association with FPE matching the 3-dimensional in vitro experiments. Analysis was conducted using IBM SPSS Statistics Version 25 (IBM Corp., Armonk, NY). Chi-square tests and bivariate logistic regressions were the main statistical tests used in analysis. A p-value of less than .05 was considered to indicate statistical significance. Ninety-five confidence intervals (95% CI) were generated. RESULTS We compared 41 thrombectomy experiments performed using patient-specific 3-dimensional in vitro models with a retrospective cohort of 41 patients treated with SR thrombectomy. We found that in the in vitro cohort, higher MCA angulation was associated with a lower likelihood of FPE (odds ratio [OR] = 0.967, 95% CI = 0.944-0.991, p = .008). Meanwhile in the in vivo cohort, higher MCA angulation was associated with a higher likelihood of FPE (OR = 1.039, 95% CI = 1.003-1.077, p = .033). Neither clot length nor location of clot (M1 vs. M2) was associated with a difference in FPE rates in either cohort. DISCUSSION Comparison of SR thrombectomy performed during actual MCA occlusion cases versus patient-specific 3-dimensional replicas revealed MCA angulation as an independent predictor of procedure success or failure. However, the opposite direction of effect was observed between the two studied environments, indicating potential limitations of studying SR thrombectomy using 3-dimensional models of LVO.
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Affiliation(s)
- Elliot Pressman
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida 33620
| | - Kelsey N Sommer
- Department of Biomedical Engineering, University at Buffalo NY 14228,Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo NY 14208
| | - Mohammad Waqas
- Department of Neurosurgery, University at Buffalo, Buffalo, NY 14208
| | - Adnan H Siddiqui
- Department of Biomedical Engineering, University at Buffalo NY 14228,Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo NY 14208,Department of Neurosurgery, University at Buffalo, Buffalo, NY 14208
| | - Ciprian N Ionita
- Department of Biomedical Engineering, University at Buffalo NY 14228,Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo NY 14208
| | - Maxim Mokin
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida 33620
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Ohara J, Fujimoto M, Tani S, Ogata H, Shimizu K, Taguchi T, Itani M, Akiyama Y. 3D Turbo Spin-echo MRI-based Mechanical Thrombectomy at Middle Cerebral Artery Bifurcations. Neurol Med Chir (Tokyo) 2021; 62:149-155. [PMID: 34880196 PMCID: PMC8918366 DOI: 10.2176/nmc.tn.2021-0179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We describe three cases with acute middle cerebral artery (MCA) occlusion. From the pre-operative MRI, including three-dimensional turbo spin-echo sequences using T1WI and T2WI, we assessed both thrombus configuration and arterial anatomy at the MCA bifurcations. For efficient endovascular thrombectomy, we identified the applied MCA segment 2 (M2) branch, in which the main thrombus was buried. Sufficient recanalization after a single pass was achieved and the patients made a marked recovery. Although mechanical thrombectomy for M2 occlusion has not been of proven benefit, the endovascular procedure based on three-dimensional turbo spin-echo imaging is useful for more complete thrombus removal at MCA bifurcations.
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Affiliation(s)
- Jiro Ohara
- Department of Neurosurgery, Tenri Hospital
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Susceptibility vessel sign as a predictor for recanalization and clinical outcome in acute ischaemic stroke: A systematic review and meta-analysis. J Clin Neurosci 2021; 94:159-165. [PMID: 34863431 DOI: 10.1016/j.jocn.2021.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 09/04/2021] [Accepted: 10/14/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the prognostic values of susceptibility vessel sign (SVS) on T2*-weighted MRI using GRE and SWI sequences for recanalization status and clinical outcomes in patients with acute ischaemic stroke undergoing different therapies. METHODS Literature search on PubMed, EMBASE databases and other sources from inception up to 01 June 2021 was conducted. 11 studies which reported SVS, recanalization and clinical outcomes were included in qualitative synthesis and meta-analysis. RESULTS Pooled analysis demonstrated significant association between good clinical outcome and SVS-positive patients who underwent mechanical thrombectomy (RR = 1.34, 95% CI = 1.07-1.67, p = 0.01), which is in line with higher recanalization rate in SVS-positive patients who were treated with mechanical thrombectomy compared to intravenous thrombolysis only. No statistically significant association was demonstrated between presence of SVS and successful recanalization, likely due to limitations in the recruited studies. CONCLUSIONS Presence of SVS in patients with acute ischaemic stroke who underwent mechanical thrombectomy is associated with good clinical outcome. SVS-positive patients treated with mechanical thrombectomy also shows better recanalization rate comparing to intravenous thrombolysis only, although not statistically significant. MRI assessment of the clot content using SVS is useful in selection of reperfusion strategy for acute ischaemic stroke and prognostication.
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Jing M, Yeo JYP, Holmin S, Andersson T, Arnberg F, Bhogal P, Yang C, Gopinathan A, Tu TM, Tan BYQ, Sia CH, Teoh HL, Paliwal PR, Chan BPL, Sharma V, Yeo LLL. Preprocedural Imaging : A Review of Different Radiological Factors Affecting the Outcome of Thrombectomy. Clin Neuroradiol 2021; 32:13-24. [PMID: 34709411 DOI: 10.1007/s00062-021-01095-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/25/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Endovascular treatment (EVT) has strong evidence for its effectiveness in treatment of acute ischemic stroke (AIS); however, up to half of the patients who undergo EVT still do not have good functional outcomes. Various prethrombectomy radiological factors have been shown to be associated with good clinical outcomes and may be the key to better functional outcomes, reduced complications, and reduced mortality. In this paper, we reviewed the current literature on these imaging parameters so they can be employed to better estimate the probability of procedural success, therefore allowing for more effective preprocedural planning of EVT strategies. We reviewed articles in the literature related to imaging factors which have been shown to be associated with EVT success. The factors which are reviewed in this paper included: anatomical factors such as 1) the type of aortic arch and its characteristics, 2) the characteristics of the thrombus such as length, clot burden, permeability, location, 3) the middle cerebral artery features including the tortuosity and underlying intracranial stenosis, 4) perfusion scans estimating the volume of infarct and the penumbra and 5) the effect of collaterals on the procedure. The prognostic effect of each factor on the successful outcome of EVT is described. The identification of preprocedural thrombectomy imaging factors can help to improve the chances of recanalization, functional outcomes, and mortality. It allows the interventionist to make time-sensitive decisions in the treatment of acute ischemic stroke.
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Affiliation(s)
- Mingxue Jing
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joshua Y P Yeo
- Department of Medicine, National University Health System, Singapore, Singapore
| | - Staffan Holmin
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Tommy Andersson
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, 171 76, Stockholm, Sweden
- Department of Medical Imaging, AZ Groeninge, 8500, Kortrijk, Belgium
| | - Fabian Arnberg
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Paul Bhogal
- Department of Neuroradiology, St.Bartholomew's and the Royal London Hospital, London, UK
| | - Cunli Yang
- Department of Diagnostic Imaging, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Anil Gopinathan
- Department of Diagnostic Imaging, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tian Ming Tu
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Benjamin Yong Qiang Tan
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ching Hui Sia
- National University Heart Centre, National University Health System, Singapore, Singapore
| | - Hock Luen Teoh
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Prakash R Paliwal
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Bernard P L Chan
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Vijay Sharma
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Leonard L L Yeo
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore.
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, 171 76, Stockholm, Sweden.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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