High-Resolution Magnetic Resonance Imaging Evidence for Intracranial Vessel Wall Inflammation Following Endovascular Thrombectomy

Li, Yangchun; Turan, Tanya N.; Chaudry, Imran; Spiotta, Alejandro M; Turk, Aquilla S; Turner, Raymond D; Chatterjee, Arindam

doi:10.1016/j.jstrokecerebrovasdis.2017.02.006

Cited by 8 publications

(4 citation statements)

References 11 publications

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“…This potential explanation is supported by previous imaging that studied the effect of IAT using a stent retriever (and one also including patients treated with a thrombosuction device) on the vessel wall on 3T MR imaging. [10][11][12][13]24 The study that also included patients treated with a thrombosuction device showed that concentric vessel wall enhancement, which occurred in, respectively, 67% and 14% of the patients in the IAT-group (n = 15) versus the non-IAT group (n = 14), was associated with the number of attempts, type of device, and more frequent hemorrhagic transformation of the ischemic infarct (mean interval of treatment to MR imaging, 3.66 6 1.52 days). 13 In another series (IAT-group, n = 6, versus non-IAT group, n = 10), MR vessel wall imaging showed wall thickening in 83% versus 30% and contrast enhancement in 67% versus 20% of patients, respectively, (mean interval of treatment to MR imaging, 3.44 6 2.58 days).…”

Section: Discussionmentioning

confidence: 99%

“…17,18 Furthermore, previous 3T MR imaging studies assessing vessel wall enhancement after treatment with stent-retriever devices have comparable findings. [10][11][12][13]24 Second, the observed vessel wall enhancement may be the result of the former occluding thrombus on the arterial vessel wall that caused reactive, inflammatory changes or a local "scarring" of the vessel wall. This possibility is supported by studies that have shown an increased level of inflammatory markers after an ischemic stroke.…”

Section: Discussionmentioning

confidence: 99%

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MRI Vessel Wall Imaging after Intra-Arterial Treatment for Acute Ischemic Stroke

Lindenholz¹,

Schaaf²,

Kolk³

et al. 2020

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Vessel wall imaging is increasingly performed in the diagnostic work-up of patients with ischemic stroke. The aim of this study was to compare vessel wall enhancement after intra-arterial thrombosuction with that in patients not treated with thrombosuction. MATERIALS AND METHODS: From 2009 to 2017, forty-nine patients with an ischemic stroke underwent 7T MR imaging within 3 months after symptom onset as part of a prospective intracranial vessel wall imaging study. Fourteen of these patients underwent intra-arterial treatment using thrombosuction (intra-arterial treatment group). In the intra-arterial treatment group, vessel walls were evaluated for major vessel wall changes. All patients underwent pre-and postcontrast vessel wall imaging to assess enhancing foci of the vessel wall using coregistered subtraction images. A Wilcoxon signed rank test was performed to test for differences. RESULTS: In the intra-arterial treatment group, 11 of 14 patients (79%) showed vessel wall enhancement compared with 17 of 35 patients without intra-arterial treatment (49%). In the intra-arterial treatment group, more enhancing foci were detected on the ipsilateral side (n ¼ 18.5) compared with the contralateral side (n ¼ 3, P ¼ .005). Enhancement was more often concentric on the ipsilateral side (n ¼ 8) compared with contralateral side (n ¼ 0, P ¼ .01). No differences were found in the group without intraarterial treatment between the number and configuration of ipsilateral and contralateral enhancing foci. CONCLUSIONS: Patients with intra-arterial treatment by means of thrombosuction showed more (concentric) enhancing foci of the vessel wall ipsilateral compared with contralateral to the treated artery than the patients without intra-arterial treatment, suggesting reactive changes of the vessel wall. This finding should be taken into account when assessing vessel wall MR images in patients with stroke.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

MRI Vessel Wall Imaging after Intra-Arterial Treatment for Acute Ischemic Stroke

Lindenholz¹,

Schaaf²,

Kolk³

et al. 2020

AJNR Am J Neuroradiol

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“…Given the same radial force as its 4 9 20 counterpart, in proportion to its length the Solitaire 2 FR 4 9 40 has more friction, which could result in more trauma to the vessel wall and more vessel straightening during retrieval of the device [14]. This assumption has been tested in previous studies showing that larger stent retrievers may cause more trauma to the vessel wall, especially if oversized [15][16][17]. In our study, we did observe more friction while placing the Solitaire 2 FR 4 9 40 via a 21 microcatheter, although this has not been objectively measured.…”

Section: Discussionmentioning

confidence: 99%

Safety of the Solitaire 4 × 40 mm Stent Retriever in the Treatment of Ischemic Stroke

Zibold

Mordasini

Mosimann

et al. 2017

Cardiovasc Intervent Radiol

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Purpose Stent retrievers apply mechanical force to the intracranial vasculature. Our aim was to evaluate the safety and efficacy of the long Solitaire 4 9 40 mm stent retriever for large vessel occlusion in stroke patients. Methods We conducted a retrospective analysis of all patients treated for acute ischemic large vessel occlusion stroke with the Solitaire 2 FR 4 9 40 device between May and October 2016 at our institution. Patient-specific data at baseline and at discharge were documented. Reperfusion was graded with the thrombolysis in cerebral infarction (TICI) classification. Postinterventional angiograms and follow-up cross-sectional imaging were used to evaluate complications. Results TICI 2b/3 recanalization was achieved in 20 of 23 patients (87.0%), in 17 patients with the first retriever pass. NIHSS improved from a mean score at presentation of 16 (range 4-36) to 11 (range 0-41) at discharge. Mean mRS score at discharge was 3 (range 0-6) and 3 (range 0-6) at 90 days post-treatment. No infarcts in other territories were observed. One patient showed a (reversible) vasospasm in the postinterventional angiogram and another a small contrast extravasation in follow-up imaging. Conclusion The Solitaire 2 FR 4 9 40 stent retriever is a safe and efficient device for large vessel occlusion acute ischemic stroke with a high recanalization rate and a low peri-and postinterventional complication rate together with a good clinical outcome. Despite potentially higher friction and shearing forces, no increased incidence of visible damage to the vessel wall was observed.

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“…This enhancement is less commonly found in patients with arterial occlusion who have been treated with medical therapy alone. 31–34 The enhancement pattern seems to be associated with the number of passes during the thrombectomy procedure and whether or not alteplase is given before thrombectomy. 34,35 Besides arterial wall enhancement, arterial wall thickening has been observed, 36 and disruptions in the blood-CSF barrier.…”

Section: Arterial Wall Imaging With Mrimentioning

confidence: 99%

Intracranial arterial wall imaging: Techniques, clinical applicability, and future perspectives

Arenillas-Lara

Dieleman

Bos

2019

International Journal of Stroke

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Purpose To review the current state of the art and future development of intracranial vessel wall imaging. Methods Recent literature review and expert opinion about intracranial arterial wall imaging. Results Intracranial large artery diseases represent an important cause of stroke and vascular cognitive impairment worldwide. Our traditional understanding of intracranial large artery diseases is based on the observation of luminal narrowing or occlusion with angiographic or ultrasound techniques. Recently, novel imaging techniques have made the intracranial artery wall accessible for noninvasive visualization. The main advantage of vessel-wall imaging as compared to conventional imaging techniques for visualization of intracranial arteries is the ability to detect vessel wall changes even before they get to cause any significant luminal stenosis. This diagnostic capacity is provoking a revolutionary change in the way we see the intracranial circulation. In this article, we will review the current state of magnetic resonance imaging and computed tomography-based intracranial arterial wall imaging, focusing on technical considerations and their clinical applicability. Moreover, we will provide the readers with our vision on the future development of vessel-wall imaging techniques. Conclusion Intracranial arterial wall imaging methods are gaining increasing potential to impact the diagnosis and treatment of patients with cerebrovascular diseases.

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High-Resolution Magnetic Resonance Imaging Evidence for Intracranial Vessel Wall Inflammation Following Endovascular Thrombectomy

Cited by 8 publications

References 11 publications

MRI Vessel Wall Imaging after Intra-Arterial Treatment for Acute Ischemic Stroke

MRI Vessel Wall Imaging after Intra-Arterial Treatment for Acute Ischemic Stroke

Safety of the Solitaire 4 × 40 mm Stent Retriever in the Treatment of Ischemic Stroke

Intracranial arterial wall imaging: Techniques, clinical applicability, and future perspectives

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