Relationship Between Magnetic Resonance Angiography–Diffusion-weighted Imaging Mismatch and Clinical Outcome in Endovascular Treatment for Acute Ischemic Stroke: Subgroup Analysis of the Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism–Japan Registry

ObjectivesPost-contrast magnetic resonance angiography (PC-MRA) enables visualization of vessel segments distal to an intra-arterial thrombus in acute ischemic stroke. We hypothesized that PC-MRA also allows clot length measurement in different intracranial vessels.MethodsPatients with MRI-confirmed ischemic stroke and intracranial artery occlusion within 24 hours of symptom onset were prospectively evaluated. PC-MRA was added to a standard stroke MRI protocol. Thrombus length was measured on thick slab maximum intensity projection images. Clinical outcome at hospital discharge was assessed by modified Rankin Scale (mRS).ResultsThirty-four patients (median age 72 years) presenting with a median National Institutes of Health Stroke Scale score of 11 and a median onset to imaging time of 116 min were included. PC-MRA enabled precise depiction of proximal and distal terminus of the thrombus in 31 patients (91%), whereas in three patients (9%) PC-MRA presented a partial occlusion. Median thrombus length in patients with complete occlusion was 9.9 mm. In patients with poor outcome (mRS ≥3) median thrombus length was significantly longer than in those with good outcome (mRS ≤2;P=0.011).ConclusionsPC-MRA demonstrates intra-arterial thrombus length at different vessel occlusion sites. Longer thrombus length is associated with poor clinical outcome.Clinical trial registrationNCT02077582; Results.

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Abstract TP15: Long-term Magnetic Resonance Angiography Follow-up of Recanalized Vessels After Mechanical Clot Extraction

Stroke ◽

10.1161/str.44.suppl_1.atp15 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Yukiko Enomoto ◽

Shinichi Yoshimura ◽

Yusuke Egashira ◽

Toru Iwama

Keyword(s):

Ischemic Stroke ◽

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Intravenous Thrombolysis ◽

Stroke Patients ◽

Extraction Device

Objectives: Endovascular treatment provides a therapeutic option for acute ischemic stroke patients who are ineligible for, or who do not respond to intravenous thrombolysis. Higher rates of recanalization by mechanical clot extraction device were reportedly associated with better clinical outcome, but the long-term patency of recanalized vessel is unknown. Methods: We retrospectively evaluated magnetic resonance angiography (MRA) at 24-hour and 3-month after the endovascular treatment in consecutive acute stroke patients who were treated with mechanical clot extraction device between Oct. 2010 and May 2012 in our institution. Results: Fourty-six patients received endovascular treatment for acute ischemic stroke and 35 were treated with mechanical clot extraction devices, Merci and/or Penumbra system, with or without adjunctive therapy. Mean age was 69±12 years, baseline median National Institutes of Health Stroke Scale score was 15 (8 to 24), and occluded vessels were the internal carotid artery in 34%, middle cerebral artery (MCA) in 54%, and vertebro-basilar artery in 11%. Successful recanalization, defined as Thrombolysis In Myocardial Infarction II or III perfusion, was obtained in 32 (91%) patients. During 24-hour after the treatment, reocclusion of the treated vessel was observed in 4 (12.5%) patients. Of 28 eligible patients, 21 (75%) patients had 3-month MRA follow-up. None of the patients had reocclusion, but clinically silent diffuse stenosis was observed in 2 (9.5%) patients. Statistically significant predictors were not identified, but both of the patients were MCA occlusion treated with Merci retriever. Conclusion: In this study, late stenosis was observed in the MCA on 3-month follow-up MRA. Long-term follow-up seems to be useful to follow the recanalized vessels, especialy when mechanical devices were used.

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Acute ischemic stroke patients with diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score ≤ 5 can benefit from endovascular treatment: a single-center experience and literature review

Neuroradiology ◽

10.1007/s00234-019-02177-1 ◽

2019 ◽

Vol 61 (4) ◽

pp. 451-459 ◽

Cited By ~ 3

Author(s):

Kangping Song ◽

Min Guan ◽

Wenxian Li ◽

Zhen Jing ◽

Xiaomei Xie ◽

...

Keyword(s):

Computed Tomography ◽

Ischemic Stroke ◽

Literature Review ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Diffusion Weighted Imaging ◽

Single Center ◽

Stroke Patients ◽

Single Center Experience ◽

Diffusion Weighted

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Diagnosis of Acute Ischemic Stroke Based on Time-To-Peak and Diffusion-Weighted Magnetic Resonance Imaging.

Neurologia medico-chirurgica ◽

10.2176/nmc.42.281 ◽

2002 ◽

Vol 42 (7) ◽

pp. 281-288

Author(s):

Keisuke MARUYAMA ◽

Tsuneyoshi EGUCHI ◽

Shigeo SORA ◽

Masafumi IZUMI ◽

Hirofumi HIYAMA ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Ischemic Stroke ◽

Magnetic Resonance ◽

Acute Ischemic Stroke ◽

Resonance Imaging ◽

Time To Peak ◽

Diffusion Weighted ◽

Weighted Magnetic Resonance Imaging ◽

And Diffusion

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1-O12 Inter-reader agreement for assessing the circle of willis anatomy in patients with acute ischemic stroke using time of flight magnetic resonance angiography

10.26226/morressier.614c36115a6b32ccbe148cfc ◽

2021 ◽

Author(s):

NIKLAS LOHAUS ◽

Sebastian Winklhofer

Keyword(s):

Ischemic Stroke ◽

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Acute Ischemic Stroke ◽

Time Of Flight ◽

Circle Of Willis

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Incidence of New Diffusion-Weighted Imaging Lesions Outside the Area of Initial Hypoperfusion Within 1 Week After Acute Ischemic Stroke

Stroke ◽

10.1161/strokeaha.112.655993 ◽

2012 ◽

Vol 43 (10) ◽

pp. 2654-2658 ◽

Cited By ~ 8

Author(s):

Tatiana Usnich ◽

Fredrik N. Albach ◽

Peter Brunecker ◽

Jochen B. Fiebach ◽

Christian H. Nolte

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Diffusion Weighted Imaging ◽

Diffusion Weighted

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Diffusion imaging of cerebral diaschisis in childhood arterial ischemic stroke

International Journal of Stroke ◽

10.1177/1747493016666089 ◽

2016 ◽

Vol 11 (9) ◽

pp. 1028-1035 ◽

Cited By ~ 10

Author(s):

Adam Kirton ◽

Elizabeth Williams ◽

Michael Dowling ◽

Sarah Mah ◽

Jacquie Hodge ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Ischemic Stroke ◽

Magnetic Resonance ◽

Diffusion Weighted Imaging ◽

Infarct Volume ◽

Resonance Imaging ◽

Arterial Ischemic Stroke ◽

Diffusion Weighted ◽

Motor Outcome

Background Diffusion-weighted imaging magnetic resonance imaging may detect changes in brain structures remote but connected to stroke consistent with neuropathological descriptions of diaschisis. Early diffusion-weighted imaging demonstrates restriction in corticospinal pathways after arterial ischemic stroke of all ages that correlates with motor outcome. Aim/hypothesis We hypothesized that cerebral diaschisis is measurable in childhood arterial ischemic stroke and explored associations with outcome. Methods This sub-study of the validation of the Pediatric NIH Stroke Scale study prospectively enrolled children with acute arterial ischemic stroke and both acute and early follow-up (5–14 days) diffusion-weighted imaging. Inclusion criteria were (1) unilateral middle cerebral artery arterial ischemic stroke, (2) acute and subacute diffusion-weighted imaging ( b = 1000), and (3) 12 month neurological follow-up (Pediatric Stroke Outcome Measure). A validated method using ImageJ software quantified diffusion-weighted imaging diaschisis in anatomically connected structures. Diaschisis measures were corrected for infarct volume, compared to age, imaging timing, and outcomes (Chi square/Fisher, Mann–Whitney test). Results Nineteen children (53% male, median 8.1 years) had magnetic resonance imaging at medians of 21 and 168 h post-stroke onset. Diaschisis was common and evolved over time, observed in one (5%) on acute but eight (42%) by follow-up diffusion-weighted imaging. Thalamic and callosal diaschisis were most common (5, 26%). Estimates of perilesional diaschisis varied (54 ± 18% of infarct volume). Children with diaschisis tended to be younger (7.02 ± 5.4 vs. 11.82 ± 4.3 years, p = 0.08). Total diaschisis score was associated with poor cognitive outcomes ( p = 0.03). Corticospinal tract diaschisis was associated with motor outcome ( p = 0.004). Method reliability was excellent. Conclusions Diffusion-weighted imaging diaschisis occurs in childhood arterial ischemic stroke. Mistaking diaschisis for new areas of infarction carries important clinical implications. Improved recognition and study are required to establish clinical relevance.

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