Abstract
Background and Purpose: An endovascular recanalization is an alternative option for symptomatic intracranial atherosclerotic steno-occlusive disease (ICAD). Accurate non-invasive alternatives to digital subtraction angiography (DSA) for follow-up imaging after endovascular treatment are desirable. We aimed to evaluate the image quality and diagnostic performance of high-resolution magnetic imaging in follow-up using DSA as a reference.Materials and Methods: From January 2017 to June 2021, data from 35 patients with 40 intracranial steno-occlusive lesions who underwent endovascular recanalization and received high-resolution magnetic resonance (HR-MR) follow-up were retrospectively collected in our prospective database. Studies were evaluated for the quality of visualization of the vessel lumen, restenosis rate, and accuracy of high-resolution magnetic resonance (HR-MR) with DSA used as the reference standard. Intraclass correlation coefficient (ICC) analyses were performed to assess the agreement between the two different readers.Results: In total, 40 intracranial steno-occlusive lesions in 35 patients, with 34 lesions undergoing balloon angioplasty [including 16 drug-coated balloons (DCBs)] and 8 lesions undergoing stenting were enrolled. The median age was 63.6 years (IQR 58.5–70.0 years), and the mean imaging follow-up time was 9.5 months (IQR 4.8–12.5 months). The median degrees of preprocedural and residual stenosis were 85.0% (IQR 75.0–99.0%) and 32.8% (IQR 15.0–50.0%), respectively. Intracranial periprocedural complications occurred in 1 (3.6%) patient. In the case of a stainless-steel stent (n = 1), there was a signal drop at the level of the vessel, which did not allow evaluation of the vessel lumen. However, this was visible in the case of nitinol stents (n = 7) and angioplasty (n = 34). The overall restenosis rate was 25.8% (n = 9). The DCB subgroup showed a lower rate of restenosis than the percutaneous transluminal angioplasty (PTA) subgroup [5.3% (2/13) vs. 35.7% (5/14)].Conclusion: High-resolution magnetic resonance may be a reliable non-invasive method for demonstrating the vessel lumen and diagnostic follow-up after endovascular recanalization for ICAD. Compared with MR angiography (MRA), HR-MR showed a higher inter-reader agreement and could provide more information after endovascular recanalization, such as enhancement of the vessel wall.
Highlights
Intracranial artery disease (ICAD) is one of the major causes of ischemic stroke and neurologic symptoms, especially in Asians [1,2,3,4]
Endovascular treatment (EVT) for ICAD is associated with a highrestenosis rate, which accounts for most subsequent recurrence of ischemic events [5]
Conventional MR angiography (MRA) and CT angiography (CTA) can be used as minimally invasive methods to assess intracranial stenosis, but artifacts can be a problem in the luminal evaluation compared with digital subtraction angiography (DSA)
Summary
Intracranial artery disease (ICAD) is one of the major causes of ischemic stroke and neurologic symptoms, especially in Asians [1,2,3,4]. EVT for ICAD is associated with a highrestenosis rate (up to 30%), which accounts for most subsequent recurrence of ischemic events [5] Lumenography, such as digital subtraction angiography (DSA), CT angiography (CTA), and MR angiography (MRA), has been essential and widely used in the diagnosis of ICAD and follow-up imaging [6]. Among these methods, DSA is thought to be the standard criterion tool because of its superior spatial and temporal resolution [7, 8]. Accurate non-invasive alternatives to digital subtraction angiography (DSA) for follow-up imaging after endovascular treatment are desirable. We aimed to evaluate the image quality and diagnostic performance of high-resolution magnetic imaging in follow-up using DSA as a reference
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