J Cerebrovasc Endovasc Neurosurg.  2021 Sep;23(3):201-209. 10.7461/jcen.2021.E2020.10.007.

Usefulness of three-dimensional fast imaging employing steady-state acquisition MRI of large vessel occlusion for detecting occluded middle cerebral artery and internal carotid artery before acute mechanical thrombectomy

• Sato K
• Hijikata Y
• Omura N
• Miki T
• Kakita H
• Yoshida T
• Shimizu F

• KMID: 2520879
• DOI: http://doi.org/10.7461/jcen.2021.E2020.10.007

Abstract

Objective
Acute mechanical thrombectomy (AMT) in patients with acute ischemic stroke from large vessel occlusion (LVO) is performed without directly identifying the occluded vessels. In this study, we evaluated whether 1.5 T magnetic resonance imaging (MRI) with 3D-fast imaging employing steady-state acquisition (FIESTA) could visualize the occluded intracranial middle cerebral artery (MCA) and internal carotid artery (ICA) before AMT.
Methods
This retrospective study included 21 consecutive patients who underwent time-of-flight magnetic resonance angiography (TOF MRA) and 3D-FIESTA MRI immediately before AMT. The patients also underwent TOF MRA after AMT and achieved TICI 2b or 3 by AMT at our hospital between February 2018 and April 2019. When LVO in the anterior circulation was detected by TOF MRA, 3D-FIESTA MRI was additionally performed. Then, the occluded intracranial MCA and ICA, including their branches, were constructed on the workstation with volume rendering. The obtained images were fused with the TOF MRA images to create combined 3D images.
Results
The length and top-to-bottom distance of the affected M1 segment (calculated by the ipsilateral-to-contralateral ratio) were 1.29 and 1.17, respectively, on 3D-FIESTA MRI before AMT and 1.34 and 1.24, respectively, on TOF MRA after AMT. We assessed the number of M2 segments branching from the affected M1/M2 junction and visualized the affected anterior temporal artery. The 3D-FIESTA MRI before AMT and TOF MRA after AMT were consistent in all patients, except for two who moved vigorously during imaging.
Conclusions
Images acquired by 1.5T 3D-FIESTA MRI can visualize to predict the existing path of the occluded MCA and ICA before AMT in patients with LVO of the anterior circulation.

Keyword

FIESTA; MRI; Large vessel occlusion; Mechanical thrombectomy

Figure

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  Fig. 1. Data collection process for patients who underwent 3D-FIESTA MRI and TOF MRA immediately before acute mechanical thrombectomy (AMT), additionally underwent TOF MRA after AMT, and achieved thrombolysis in cerebral infarction (TICI) grade 2b or 3 by AMT at our hospital between February 2018 and April 2019. We excluded 31 patients for various reasons, and 21 patients were included in this study. 3D-FIESTA, three-dimensional fast imaging employing steady-state acquisition; MRI, magnetic resonance imaging; TOF MRA, time-of-flight magnetic resonance angiography.

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  Fig. 2. Example of a patient with measured top-to-bottom distance (dotted line) and length of the affected M1 segment (solid line) on time-of-flight MR angiography.

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  Fig. 3. Preoperative TOF MRA (A), DWI (B), FLAIR (C), FIESTA MRI (D), fusion (TOF MRA and FIESTA MRI) MR (E), and cerebral angiography (F) in a case in which right MCA (M1 segment) occlusion was observed. Cerebral angiography after the direct aspiration technique using the Penumbra system in the right MCA (M1 segment) showed occlusion in the recanalized right M2 segment, except for the right anterior temporal artery (G). Cerebral angiography after stent retriever deployment in the right anterior temporal artery (H). Postoperative TOF MRA (I). TOF MRA, time-of-flight magnetic resonance angiography; DWI, diffusion weighted image; FLAIR, fluid attenuated inversion recovery; MRI, magnetic resonance imaging; MCA, middle cerebral artery.

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  Fig. 4. Preoperative TOF MRA (A), fusion (TOF MRA and FIESTA MRI) MR (B), and cerebral angiography (C) in a case in which left MCA (M1 segment) occlusion was observed. Cerebral angiography after the first pass of stent retriever deployment in the left MCA (D). Cerebral angiography after the second pass of stent retriever deployment in the left residual occluded M2 segment of the trifurcation of the MCA (E). Postoperative TOF MRA (F). TOF MRA, time-of-flight magnetic resonance angiography; FIESTA, fast imaging employing steady-state acquisition; MRI, magnetic resonance imaging; MCA, middle cerebral artery.

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