Abstract
PurposeReports from 3-T vessel wall MRI imaging have shown contrast enhancement following thrombectomy for acute stroke, suggesting potential intimal damage. Comparisons have shown higher SNR and more lesions detected by vessel wall imaging when using 7 T compared with 3 T. The aim of this study was to investigate the vessel walls after stent retriever thrombectomy using high-resolution vessel wall imaging at 7 T.MethodsSeven patients with acute stroke caused by occlusion of the distal internal carotid artery (T-occlusion), or proximal medial cerebral artery, and treated by stent retriever thrombectomy with complete recanalization were included and examined by 7-T MRI within 2 days. The MRI protocol included a high-resolution black blood sequence with prospective motion correction (iMOCO), acquired before and after contrast injection. Flow measurements were performed in the treated and untreated M1 segments.ResultsAll subjects completed the MRI examination. Image quality was independently rated as excellent by two neuroradiologists for all cases, and the level of motion artifacts did not impair diagnostic quality, despite severe motion in some cases. Contrast enhancement correlated with the deployment location of the stent retrievers. Flow data showed complete restoration of flow after treatment.ConclusionVessel wall imaging with prospective motion correction can be performed in patients following thrombectomy with excellent imaging quality at 7 T. We show that vessel wall contrast enhancement is the normal post-operative state and corresponds to the deployment location of the stent retriever.
Highlights
Stroke is the second cause of mortality worldwide, the second cause of dementia, and the most common cause of adult disability [1]
The results of the image assessment by the two neuroradiologists are shown in Tables 2 and 3. Both reviewers identified vessel wall Gd uptake on the side that had been treated during the thrombectomy, and in all cases both reviewers agreed that the Gd uptake correlated to the location of the stent retriever rather than to the site of the embolus (Table 2)
We conclude that 7-T vessel wall imaging with prospective motion correction in the sub-acute phase following endovascular thrombectomy is safe, robust, and reliably yields excellent diagnostic images
Summary
Stroke is the second cause of mortality worldwide, the second cause of dementia, and the most common cause of adult disability [1]. 80% of all strokes are ischemic [2], Neuroradiology (2019) 61:1145–1153 i.e., caused by thromboembolic occlusion of a vessel. Following several randomized controlled trials showing the superiority of endovascular thrombectomy over solely intravenous thrombolysis, endovascular thrombectomy has been established as the standard of care for acute stroke with large vessel occlusion [3,4,5,6,7]. There is accumulating evidence that vessel wall imaging of intracranial vessels can be readily performed with MRI at field strengths of 3 and 7 T [8,9,10,11,12,13]. MRI is capable of quantifying blood flow in individual vessels within the circle of Willis [14]
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