Usefulness of the Preoperative Images Supporting Mechanical Thrombectomy Based on Susceptibility-Weighted Image for Stroke.

Objective: This is a report on the usefulness of 3D fusion imaging with susceptibility-weighted imaging (SWI) as preoperative imaging for mechanical thrombectomy (MT) for acute ischemic stroke (AIS). Case Presentations: Among 17 cases of patients who underwent MT in AIS between March 2021 and April 2022, 14 patients who underwent MRI with SWI (shortened SWI for stroke) and 3D T2-weighted sampling perfection with application-optimized contrasts using different flip angle evolution were targeted in the study. Three cases with motion artifacts due to body movement were excluded from the images.After imaging, 3D fusion images were constructed to visualize thrombi and occluded vessels. SWI for stroke obtained thrombus information in 11 of the 14 cases (78.5%) and 3D images of the thrombi could be created in all 11 cases. 3D fusion images could be created in nine of the 14 cases (64.2%). Conclusion: 3D fusion images, using SWI for stroke, can visualize thrombi and occluded vessels and may be effectively used as preoperative images for MT.

3D T2-Weighted Sampling Perfection with Application-Optimized Contrasts Using Different Flip Angle Evolutions (SPACE) and 3D Time-of-Flight (TOF) MR Angiography Fusion Imaging for Occluded Intracranial Arteries.

Objective: Determining the course of occluded vessels in advance will increase the success rate and safety of mechanical thrombectomy (MT). Herein, we evaluate the usefulness of MR fusion images created via 3D T2-weighted sampling perfection with application-optimized contrasts using different flip angle evolutions (T2-SPACE) and 3D time-of-flight (TOF)-MRA for visualization of occluded vessels in patients with acute ischemic stroke (AIS) before MT. Methods: We enrolled 26 patients with AIS caused by intracranial large vessel occlusion who presented at our hospital and underwent MRI with fusion images unaffected by motion artifacts in our study. All patients underwent T2-SPACE and TOF-MRA followed by MT. We created fusion images of the T2-SPACE and TOF-MRA by combining a translucent image of the occluded artery produced by the flow void effect in T2-SPACE with the same vessel in a TOF-MRA image. Fusion images were compared with post-recanalization angiography and post-recanalization MRA, respectively, and the degree of agreement in depiction of M1 runs and M2 branching beyond the occlusion on three levels was assessed. Imaging evaluations were performed independently by two endovascular specialists. Results: The interobserver agreement of the MRI findings about the concordance of the occluded vessel's run was excellent (kappa was 0.87 [confidence interval: 0.61-1.12]). In all, 21 patients (80.8%) had excellent imaging, four (15.4%) had fair imaging, and one (3.8%) had a divided opinion of the rating between excellent and fair imaging. No cases were judged to be poorly drawn. Even if there was a localized signal loss, its distal portion could be delineated, so it did not affect the estimation of the entire vessel run, and we found that the anatomical structures of the occluded vessels were distinctly visible in the fusion images. Conclusion: We demonstrated that MR fusion images derived using T2-SPACE and MRA methodologies could determine the courses of occluded vessels prior to MT performed for AIS. Fusion MR imaging may have potential as a preoperative test for ensuring effective and safe MT procedures.

A proposed method for outlining occluded intracranial artery using 3D T2-weighted sampling perfection with application optimized contrasts using different flip angle evolution (SPACE).

High-resolution vessel wall imaging techniques have been developed for clinical use in various types of intracranial artery disease. Numerous studies have described techniques for evaluating remodeling patterns and plaque character, but few have reported a method for outlining obstructed vessels in intracranial artery occlusion. The course of the vessel affects the success of recanalization and can cause complications in mechanical thrombectomy for acute ischemic stroke. We propose imaging with 3D T2-weighted sampling perfection with application optimized contrasts using different flip angle evolution (SPACE) as a useful tool for describing the course of an occluded artery in ischemic stroke due to intracranial artery occlusion.

Utility of 3D T2-weighted Sampling Perfection with Application-optimized Contrasts Using Different Flip Angle Evolution (SPACE) and 3D Time-of-flight (TOF) MRA Fusion Imaging in Acute Intracerebral Artery Occlusion.

Objective: The course of the vessel affects the success of recanalization and can cause complications in mechanical thrombectomy (MT); however, no study has been reported a method for outlining vessel course prior to MT. We propose magnetic resonance (MR) fusion images as a useful tool in MT for acute ischemic stroke. Case Presentations: A 73-year-old woman and a 79-year-old man were admitted to our hospital with left hemiparesis. In both patients, MR revealed acute ischemic stroke due to right middle cerebral artery (MCA) occlusion. MR fusion images were created with 3D T2-weighted sampling perfection with application-optimized contrasts using different flip angle evolution (SPACE) and 3D time-of-flight (TOF) MRA acquired before MT clearly revealed the occluded right MCA. In both cases, the fusion image is enabled information about the course of the right MCA and its branches to be obtained prior to performing MT. The thrombi were removed with a stent retriever and reperfusion catheter with no complications, and there was remarkable resolution of symptoms in both patients immediately after the procedure. Conclusion: A fusion image of T2-weighted SPACE and 3D TOF MRA appears to be a simple and effective method for determining the course of the occluded vessel prior to MT for acute ischemic stroke. This technique will enable good recanalization in MT for acute ischemic stroke and should reduce complications.

Significance of blood aspiration in carotid artery stenting with Angioguard XP.

BACKGROUND AND PURPOSE: In some patients, angiographic flow impairment is observed during carotid artery stenting (CAS) using Angioguard XP (AGXP), resulting in neurological symptoms. CAS was thus modified to improve clinical outcome. METHODS: Ninety-seven patients were treated with CAS using AGXP from January 2008 to October 2009. In period I (January-December 2008; n = 53), blood aspirations were performed only in no-flow cases. In period II (January-October 2009; n = 44), blood aspirations were performed in no-flow and slow-flow cases. Clinical outcome, detection of microembolic lesions on diffusion-weighted imaging (DWI) and flow impairment during CAS were examined between these two periods before and after modifying the CAS procedure. RESULTS: Periprocedural transient ischemic attacks occurred in 10 patients (18.9%) and one patient (2.27%) in periods I and II, respectively (P = .018). Minor and major strokes were observed in two patients in each period (P = .849). New ipsilateral DWI lesions were detected in 25 patients (47.2%) and 11 patients (25.0%) in periods I and II, respectively (P = .024). Among 18 slow-flow cases, new DWI lesions were detected in one patient (9.09%) and five patients (71.4%) with (n = 11) and without (n = 7) blood aspirations, respectively (P = .013). Neurological symptoms were observed only in three of seven patients (42.9%) without aspirations, compared to one of 11 patients (9.1%) with aspirations (P = .043). CONCLUSION: Postoperative symptomatic stroke and new DWI lesions are significantly associated with blood flow impairment during CAS using AGXP. When flow impairment occurs, blood aspiration should be performed.

[Progress of the Laboratory Consultation Office in Kyoto Prefectural University Hospital].

In an attempt to assist the clinical physicians at the outpatient clinics in Kyoto Prefectural University Hospital, we opened the laboratory consultation office in January 2005. This office is staffed by one medical technologist from 9 am to 4 pm on weekdays. The technologist shows the laboratory examination result of respective patient, and then explains the significance of reference interval using the personal computer. Additional explanation such about the mechanism of abnormal result or the general interpretation of diagnostic tests is also performed according to the patients' demands. Whereas, as the major premise, the consulting technologist never comments to the patients on the clinical relevance between their laboratory results and their own disease courses. Until March 2006, 1,430 outpatients have visited the office in total, resulting in 6.1 patients/day as mean value. Almost all of the visitors (97.9%) wanted to listen to the meaning of liver function test, which was followed by renal function test (95.3%). Consulting time required for respective patient has been quite variable from 10 to 120 minutes (30 minutes/patient as mean). The questionnaire survey after consultation revealed that all of the visitors felt satisfactory for consultation, and wanted to revisit to our laboratory consultation office. We believe that the laboratory consultation office contributes as a new medical service of our hospital to outpatients.