MRI quantitative T2* mapping on thrombus to predict recanalization after endovascular treatment for acute anterior ischemic stroke

BACKGROUND

In anterior acute ischemic stroke (AAIS) treated with endovascular treatment (EVT), the susceptibility vessel sign (SVS+ or SVS-) is related to recanalization results (TICI 2b/3) and clinical outcome. However, a binary qualitative assessment of thrombus using SVS does not reflect its complex composition. Our aim was to assess whether a quantitative MRI marker, Thrombus-T2* relaxation time, may be assessable in clinical routine and may to predict early successful recanalization after EVT, defined as a TICI 2b/3 recanalization obtained in 2 attempts or less.

MATERIAL AND METHODS

Thrombus-T2* relaxation time was prospectively obtained from consecutive AAIS patients treated by EVT (concomitant aspiration and stent retriever). Quantitative values were compared between early recanalization and late or unsuccessful recanalization.

RESULTS

Thirty patients with AAIS were included and Thrombus-T2* relaxation time was obtained in all patients. Earlier TICI 2b/3 recanalization were obtained in 22 patients (73%) and was significantly associated with SVS+ (1/8 vs. 16/22, P=0.01) and a shorter Thombus-T2* relaxation time (mean SD, range: 257, 18-50ms vs. 45 9, 35-60ms, P<0.001).

CONCLUSION

A new quantitative MRI biomarker, the Thrombus-T2* relaxation time is assessable in clinical routine. In a preliminary study of 30 patients, a shorter Thombus-T2* relaxation time is related to earlier recanalization after EVT using combination of stent retriever and aspiration.

Is there an inherited anatomical conformation favoring aneurysmal formation of the anterior communicating artery?

OBJECTIVE The pathophysiological mechanisms responsible for the formation of intracranial aneurysms (IAs) remain only partially elucidated. However, current evidence suggests a genetic component. The purpose of this study was to investigate the specific anatomical variations in the arterial complex that are associated with the presence of anterior communicating artery (ACoA) aneurysms in the familial forms of IAs. METHODS This multicenter study investigated bifurcation IAs in patients who had a sporadic ACoA IA without a family history of IA (SACAA group), in patients who had an ACoA IA with a family history of IA (FACAA group), and in their healthy first-degree relatives (HFDRs). Through the use of MR angiography (MRA) reconstructions, the symmetry of the A₁ segments and the angle between the A₁ and A₂ segments were analyzed on 3D models for each group. These measurements were then compared among the 3 groups. RESULTS Twenty-four patients with SACAA, 24 patients with FACAA, and 20 HFDRs were included in the study. Asymmetrical configuration of the A₁ segments was more frequent in the FACAA group than in the HFDR group (p = 0.002). The aneurysm-side A₁-A₂ angle was lower in the FACAA group (p = 0.003) and SACAA group (p = 0.007) than in the HFDR group. On the contralateral side, there was no difference in A₁-A₂ angles between groups. CONCLUSIONS The anatomical shape of the ACoA complex seems to be similarly associated with the presence of ACoA IAs in both the FACAA and SACAA groups. This highlights the role played by hemodynamic constraints in aneurysm formation and questions the hypothesis of the hereditary character of these anatomical shapes.