3D-FIESTA Magnetic Resonance Angiography Fusion Imaging of Distal Segment of Occluded Middle Cerebral Artery

Abstract

Middle cerebral artery (MCA) occlusion was examined with basi-parallel anatomical scanning (BPAS) using three-dimensional fast imaging employing steady-state acquisition (3D-FIESTA), and 3D-FIESTA and magnetic resonance angiography (MRA) fusion images were created. We expected that an incidence of hemorrhagic complications due to vessel perforations would be decreased by obtaining vascular information beyond the occlusion and thus acute endovascular revascularization could be performed using such techniques. We performed revascularization for acute MCA occlusion for five patients who were admitted in our hospital from October 2012 to October 2014. Patients consisted of 1 man and 4 women with a mean age of 76.2 years (range: 59–86 years). Fusion images were created from three-dimensional time of flight (3D-TOF) MRA and 3D-FIESTA with phase cycling (3D-FIESTA-C). Then thrombectomy was performed in all the 5 patients. Merci retriever to 1 patient, Penumbra system to 1, urokinase infusion to 2, and Solitaire to 1 using such techniques. In all cases, a 3D-FIESTA-MRA fusion imaging could depict approximately clear vascular information to at least the M3 segment beyond the occlusion. And each acute revascularization was able to perform smoothly using these imaging techniques. In all cases, there was no symptomatic hemorrhagic complication. It showed that 3D-FIESTA MRA fusion imaging technique could obtain vascular information beyond the MCA occlusion. In this study, no symptomatic hemorrhagic complications were detected. It could imply that such techniques were useful not only to improve treatment efficiency but also to reduce the risk of development of hemorrhagic complications caused by vessel perforations in acute revascularization.

Mechanical thrombectomy in acute stroke for superior limb of the fenestration of the middle cerebral artery

“…However, in an urgent situation to treat an AIS patient, it is difficult to recognize a fenestrated MCA in an occluded vessel before endovascular recanalization, as in the present case. Basi-parallel anatomic scanning (BPAS) using 3-dimensional fast imaging employing steady-state acquisition (3D-FIESTA) makes it possible to show clear vascular information of the outside of the MCA even if there is no blood flow [8] . BPAS may be useful to recognize anatomic information about an obstructive lesion of the MCA.…”

Magnetic Resonance Angiography and Cisternography fused images in acute ischemic stroke may save time during endovascular procedure revealing vessel anatomy

“…Nonetheless, this study was performed on a single patient in his eighties with an AIS who did not undergo EVT. Kuribara et al used a similar fusion technique between MRA and MRC 3D-FIESTA on 5 patients affected by AIS [20]: the reported acquisition time of MRC (3 T) was 137 s, and the automatic fusion was performed in less than 10 minutes [20].…”

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

“…Prediction of the course of the MCA by imaging retrograde flow using cone beam computed tomography and by using 3D fast imaging employing steady-state acquisition have been reported, 9,10 but it is unclear which method is most appropriate to obtain information regarding the course of the occluded vessel that would be sufficient to support MT. We have included only one case in this report; however, we plan to acquire fusion images in more patients and perform more detailed studies in the future.…”