Abstract
Objectives: To assess whether performing a pre-intervention gadolinium-enhanced extracranial magnetic resonance angiogram (MRA) in addition to intracranial vascular imaging is associated with improved thrombectomy time metrics.Methods: Consecutive patients treated by MT at a large comprehensive stroke center between January 2012 and December 2017 who were screened using pre-intervention MRI were included. Patients characteristics and procedural data were collected. Univariate and multivariate analysis were performed to compare MT speed, efficacy, complications, and clinical outcomes between patients with and without pre-intervention gadolinium-enhanced extracranial MRA.Results: A total of 912 patients were treated within the study period, including 288 (31.6%) patients with and 624 (68.4%) patients without extracranial MRA. Multivariate analysis showed no significant difference between groups in groin puncture to clot contact time (RR = 0.93 [0.85–1.02], p = 0.14) or to recanalization time (RR = 0.92 [0.83–1.03], p = 0.15), rates of successful recanalization (defined as a mTICI 2b or 3, RR = 0.93 [0.62–1.42], p = 0.74), procedural complications (RR = 0.81 [0.51–1.27], p = 0.36), and good clinical outcome (defined by a mRS ≤ 2 at 3 months follow-up, RR = 1.05 [0.73–1.52], p = 0.79).Conclusion: Performing a pre-intervention gadolinium-enhanced extracranial MRA in addition to non-contrast intracranial MRA at stroke onset does not seem to be associated with a delay or shortening of procedure times.
Highlights
Recent guidelines of the American Heart Association (AHA) recommend performing emergency intracranial vessel imaging to demonstrate the presence of a large vessel occlusion (LVO) in mechanical thrombectomy (MT) candidates (Class I evidence) and suggest performing additional pre-intervention non-invasive extracranial vascular imaging (Class IIb evidence) [1]
The superfast acquisition speed of high quality angiographic imaging for both head and neck regions, the single dose of iodinated contrast required for a comprehensive examination, and the low incidence of renal complications following CT angiography (CTA) in stroke patients [2] are three pillars of CTA that don’t lend themselves to magnetic resonance imaging (MRI) when employed for stroke acute screening
From January 2012 to December 2017, 912 AIS patients with LVO underwent MT based on MRI pre-intervention screening
Summary
Recent guidelines of the American Heart Association (AHA) recommend performing emergency intracranial vessel imaging to demonstrate the presence of a large vessel occlusion (LVO) in mechanical thrombectomy (MT) candidates (Class I evidence) and suggest performing additional pre-intervention non-invasive extracranial vascular imaging (Class IIb evidence) [1]. MRI screening consists of four short sequences, namely the diffusion-weighted imaging (DWI) [3], the fluid-attenuation-inversion-recovery (FLAIR) [4, 5], gradient-echo (GRE) or susceptibility-weightedimaging [6, 7], and intracranial magnetic resonance angiogram (MRA) with time-of-flight (TOF) [1]. These are sufficient for the acute medical or interventional management of ischemic stroke and for the diagnosis of intracranial hemorrhage. We aimed to assess whether performing a pre-intervention extracranial vessels Gadolinium-enhanced MRA is associated with improved procedure speed
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