Optimal catheter selection for acute stroke patients with type III aortic arch based on magnetic resonance angiography road mapping of the para-aortic trans-femoral access route before mechanical thrombectomy.

BACKGROUND: Although mechanical thrombectomy for acute ischemic stroke has a high recanalization rate, procedurally challenging lesions remain in approximately 10% of the cases. Type III aortic arches, due to their anatomical configuration, are a fundamental problem impacting this procedure. This study aimed to determine whether optimal catheter selection for type III aortic arches, using magnetic resonance angiography (MRA)-based road mapping of the para-aortic transfemoral access route, reduces the time required for mechanical thrombectomy. METHODS: We retrospectively evaluated 203 consecutive patients who underwent mechanical thrombectomy at multiple centers between April 2018 and July 2022. Twenty-three patients were diagnosed with a type III aortic arch using MRA-based road mapping performed to visualize the para-aortic access route before neuro-interventional procedures. Among the 23 patients with type III aortic arches, 10 received a Simmons-type catheter (initial Simmons group) and 13 received a JB-2-type catheter® (initial JB-2 group) as their first inner catheter. The time required for mechanical thrombectomy was compared between the groups. RESULTS: Compared with the initial JB-2 group, the initial Simmons group exhibited a significantly shorter "puncture-to-recanalization time" (105 vs. 53 min, p = 0.009) and "door-to-recanalization time" (164 vs. 129 min, p = 0.032). CONCLUSIONS: Optimal catheter selection by identifying the aortic arch before mechanical thrombectomy using MRA-based road mapping effectively reduced the mechanical thrombectomy time. This suggests that even in type III aorta cases, appropriate catheter selection may shorten the mechanical thrombectomy time and improve acute ischemic stroke prognosis.

Comparison of Access Route for Endovascular Treatment by Time-Spatial Labeling Inversion Pulse (Time-SLIP) MRA and Contrast-Enhanced MRA.

Objective: In endovascular treatment, it is important to evaluate the access route for placing a catheter into the common carotid artery (CCA) promptly and safely prior to the procedure. We examined whether non-contrast MRA using time-spatial labeling inversion pulse (Time-SLIP) can be used in patients prior to endovascular thrombectomy for acute ischemic stroke. We compared Time-SLIP MRA to contrast-enhanced (CE) MRA and evaluated the efficacy in the evaluation of access routes. Methods: We retrospectively reviewed 31 patients admitted between October 2018 and December 2018 for cerebral infarction at our hospital. Blood vessels were imaged from the aortic arch to the CCA. A radiologist blindly evaluated quality score, stenosis, shape of the aorta, and degree of tortuosity. Results: There were no "non-diagnostic" images. The sensitivity, specificity, positive predictive value, and negative predictive value for stenosis were 83%, 96%, 83%, and 96%, respectively. The sensitivity for the aorta type classification was 100%. The sensitivity for mild tortuosity was 93%, for moderate was 100%, and for severe was 100%. Conclusion: Time-SLIP MRA can be an alternative to CE MRA in access route assessment for patients with cerebral infarction who are not eligible for acute thrombectomy therapy.

MR vessel-encoded arterial spin labeling with the placement of metallic items to visualize the territorial blood flow after extracranial-intracranial bypass surgery: a proof-of-concept study.

BACKGROUND: Depiction of bypass blood flow in patients who received extracranial-intracranial (EC-IC) bypass surgery is important for patient care. PURPOSE: To develop a vessel-encoded arterial spin labeling (VE-ASL) method using surgical staples as a magnetic resonance (MR)-conditional product in patients who received EC-IC bypass surgery. MATERIAL AND METHODS: Pseudo-continuous labeling was used for VE-ASL acquisition with a 3-T MR unit. First, an experimental study was conducted to determine the appropriate number of surgical staples to obtain a spatially sufficient saturation effect. Thereafter, four healthy normal volunteers underwent a VE-ASL study to confirm the sufficiency of the saturation effect to the right or left common carotid artery. Finally, VE-ASL scanning was performed in seven patients after EC-IC bypass surgery to confirm the ability of VE-ASL to visualize the territorial bypass perfusion. All qualitative evaluation was performed by two neuroradiologists using a 3-point grading system (2 = good, 1 = moderate, 0 = poor). RESULTS: A quantity of 200 staples was found to be appropriate for VE-ASL scanning. In healthy volunteers, one neuroradiologist rated the images of all four cases as good, while the other rated three cases as good and one case as moderate. For the seven patients after EC-IC bypass surgery, one neuroradiologist rated all seven cases as good, and the other rated six cases as good and one case as moderate. CONCLUSION: VE-ASL using surgical staples might be useful for the evaluation of territorial bypass perfusion in patients after EC-IC bypass surgery.

Efficacy of the MRA-Based Road Mapping of the Para-Aortic Access Route before Mechanical Thrombectomy in Patients with Acute Ischemic Stroke.

INTRODUCTION: The aim of this study was to clarify whether magnetic resonance angiography (MRA)-based road mapping of the para-aortic transfemoral access route can reduce the procedural time of mechanical thrombectomy in patients with acute ischemic stroke. We further investigated the role of pre-procedural MRA-based road mapping in optimal initial catheter selection for rapid mechanical thrombectomy. MATERIALS AND METHODS: We retrospectively reviewed 57 consecutive patients with acute ischemic stroke who underwent mechanical thrombectomy at our hospital between April 2018 and May 2021. Twenty-nine patients underwent MRA-based road mapping to visualize the para-aortic access route, whereas 28 patients only underwent routine head magnetic resonance imaging/angiography without MRA-based road mapping before neuro-interventional procedures. We then compared the basic procedural times required for mechanical thrombectomy, such as the time from femoral artery puncture to recanalization ("puncture to recanalization time") and the time from the admission to recanalization ("door to recanalization time"), between the groups. RESULTS: MRA-based road mapping significantly reduced the "puncture to recanalization time" (52.0 min vs. 70.0 min; p = 0.019) and the "door to recanalization time" (146 min vs. 183 min; p = 0.013). CONCLUSION: MRA-based road mapping of the para-aortic access route is useful to reduce the procedural time of mechanical thrombectomy in acute stroke patients, possibly by enabling optimal initial catheter selection during the procedure.

Improved Depictions of the Anterior Choroidal Artery and Thalamoperforating Arteries on 3D-CTA Images Using Model-based Iterative Reconstruction.

RATIONALE AND OBJECTIVES: To evaluate the depictability of intracranial small arteries using high-resolution CTA with model-based iterative reconstruction (MBIR). MATERIALS AND METHODS: We retrospectively analyzed 21 patients who underwent brain 3D-CTA. Axial and volume-rendered (VR) images were reconstructed from the 3D-CTA raw data using adaptive statistical image reconstruction (ASIR) and MBIR. As a quantitative assessment, intra-arterial CT values of the ICA and contrast-to-noise ratio were measured to evaluate vessel enhancement. Additionally, CT values and standard deviations (SDs) of CT values and signal to noise ratio in white matter parenchyma were measured to evaluate background noise. As a qualitative assessment, the degree of vessel depictability in the anterior choroidal artery (AchoA) and the perforating branches of thalamoperforating arteries (TPA) on VR images using two different reconstruction algorithms was visually evaluated using a 3-point grading system. RESULTS: The CT value of the ICA [605.27± 89.76 Hounsfield units (HU)] was significantly increased and the SD value (i.e., image noise) of the white matter parenchyma [6.79 ± 0.81(HU)] was decreased on MBIR compared with ASIR [546.76 ± 85.27 (HU)] and [8.04 ± 1.08 HU)] (p <.05 for all). Contrast-to-noise ratio of ICA [84.48 ± 20.17] and signal to noise ratio of white matter [6.18 ± 0.75] with MBIR were significantly higher than ASIR [65.98 ± 13.08] and [5.28 ± 0.78] (p < 0.05 for all). In addition, depictions of the AchoA and TPA on VR images were significantly improved using MBIR compared with ASIR (p < 0.05). CONCLUSION: MBIR allows depiction of small intracranial arteries such as AchoA and TPA with better visibility than ASIR without increasing the dose of radiation and the amount of contrast agent.

Delivering the diluted contrast agent with saline via a spiral flow tube improves arterial enhancement for contrast enhancement of magnetic resonance angiography of the neck: A retrospective study.

A contrast agent can be pushed by a saline solution more effectively through a spiral flow tube than through a conventional T-shaped tube in contrast-enhanced magnetic resonance angiography (CEMRA). To compare the degree of contrast enhancement and signal stability in the carotid artery by using CEMRA between a spiral flow tube and a T-shaped tube.A total of 100 patients were analyzed in this retrospective study. The first 50 patients underwent CEMRA of the carotid artery with the T-shaped tube, while the last 50 patients used the spiral flow tube. Gadoterate meglumine was diluted with saline to make a total volume of 20 mL. Injection was performed with a bolus rate of 2.5 mL/s for 8 seconds. Five regions of interest (ROIs) were placed on the contrast-enhanced area in each carotid artery and the signal intensity (SI) in the ROI was used for the analysis. The ROIs on the brain stem were also placed and the average SI in this ROI was used as a reference signal. The enhancement of the artery (Eartery) was calculated as a normalized signal using the following equation: Eartery = SI in the ROI of the carotid bifurcation/SI in the ROI of the brain stem. Signal homogeneity in the contrast-enhanced area (SHenhance) was assessed by calculating the coefficient of variation from the SI in the 5 ROIs. The value of SHenhance and Eartery between the data obtained from the spiral flow tube and the T-shaped tube were compared. P-values <.05 were considered significant.We found a significant difference in SHenhance between the data obtained from the spiral flow tube (0.20 ±â€Š0.060) and the T-shaped tube (0.24 ±â€Š0.056) (P = .001). The Eartery values significantly increased by 15% (spiral flow tube, median 14.1 with interquartile range [IQR] 11.8-15.4 vs T-shaped tube, median 12.3 IQR 11.3-14.0, P = .02) using the spiral flow tube.These findings suggest that, by using the Spiral flow tube, the homogeneity of the contrast-enhanced signal intensity in the carotid artery was significantly improved without decreasing the signal intensity in CEMRA.

Improvement of the diagnostic accuracy of MRA with subtraction technique in cerebral vasospasm.

PURPOSE: Vasospasm has been considered the most severe acute complication after subarachnoid hemorrhage (SAH). MRA is not considered ideal for detecting cerebral vasospasm because of background including the hemorrhage. The aim of this study is to evaluate the efficacy of Subtraction MRA (SMRA) by comparing it to that of conventional MRA (CMRA) for diagnosis of cerebral vasospasm. METHODS: Arteries were assigned to one of three categories based on the degree of MRA diagnostic quality of vasospasm (quality score): 0, bad … 2, good. Furthermore each artery was assigned to one of four categories based on the degree of vasospasm severity (SV score): 0, no vasospasm … 3, severe. The value of the difference between DSA-SV score and MRA-SV score was defined as the DIF score. CMRA and SMRA were compared for each arterial region with regard to quality score and DIF score. RESULTS: The average CMRA and SMRA quality score were 1.46 and 1.79; the difference was statistically significant. The average CMRA and SMRA DIF score were 1.08 and .60; the difference was statistically significant. CONCLUSIONS: Diagnosis of cerebral vasospasm is more accurate by SMRA than by CMRA. The advantages are its noninvasive nature and its ability to detect cerebral vasospasm.

[Application of flow-sensitive alternating inversion recovery (FAIR) to brain functional imaging].

Flow-sensitive alternating inversion recovery (FAIR), which is an excellent method of non-invasive assessment of cerebral blood flow (CBF), was applied to brain function. Because blood oxygenation level dependent (BOLD) is an established method at present, brain functional imaging by FAIR was compared with BOLD. A few minutes is the necessary scanning time in FAIR targeted for brain ischemia. For BOLD, however, scanning time in a state is several seconds. A method of improving problems with scanning time was examined. There was no problem about the stability of the signal when scanning in design method, and a similar signal change was able to be confirmed. Additionally, there was no difference between each method concerning the activated part (p > 0.05). However, the activated area in FAIR was smaller than in BOLD (p < 0.01). Brain functional imaging by FAIR offers fewer advantages than BOLD. Yet it seems that reliability increases when measurements are made by the two methods using different mechanisms.

[Influence exerted by MPG-directions on diffusion tensor imaging (DTI)].

When diffusion tensor was analyzed, increasing motion probing gradient (MPG) directions and increasing signal-to-noise ratio (SNR) as result might influence diffusion tensor calculation. This study determined that mean diffusivity (MD) and fractional anisotropy (FA) are calculated by changing MPG-directions or SNR in the volunteer. There were no statistically significant differences in MD, which is calculated from all scanning parameters (p>0.05). FA of the caudate nucleus was similar as well. However, there were statistically significant differences between FA calculated from 31 MPG-directions and from 13 MPG-directions or less for the frontal lobe and caudate nucleus (p<0.05). If SNR of a trace image is 30 or more, FA wasn't affected by SNR (p>0.05). To calculate FA, minimum MPG-directions that were not statistically different compared with 31 MPG-directions were 15 MPG-directions (p<0.05).