Magnetic resonance angiography in patients with acute stroke treated by local thrombolysis

Abstract

Although magnetic resonance angiography (MRA) is accepted for showing chronic intracranial stenotic or occlusive lesions, the method has not been practically examined in patients with acute cerebral ischaemia. We carried out three-dimensional time-of-flight MRA in six patients with acute ischaemia treated by local thrombolysis, and compared the findings with those of digital subtraction angiography (DSA). In all patients, MRA before thrombolysis clearly demonstrated the occluded arteries, which corresponded precisely to those shown by DSA. In four patients with complete recanalisation of the occluded vessels after thrombolysis, the recanalisation could be demonstrated by postoperative MRA. In one patient with reocclusion of the recanalised artery, repeat MRA also demonstrated the reocclusion, confirmed by DSA. These results suggest that MRA may be helpful for noninvasive investigation before and after thrombolysis.

Diagnosis of stroke with advanced CT and MR imaging

“…MRA is discussed in detail in a separate chapter. It is worth mentioning that, in the context of acute stroke, MRA has been shown to correlate well with conventional angiography in demonstrating vascular occlusion prior to and recanahsation following thrombolytic treatment 24 .…”

Imaging in acute ischaemic stroke: essential for modern stroke care

“…Assessment of the intracranial vasculature with TOF-MRA in the setting of acute stroke allows depiction of large-vessel occlusion. Guidance from the American Heart Association recommends that, in the acute setting, this should only be performed if it does not delay intravenous thrombolysis within 0–3 h of ictus or if intra-arterial thrombolysis or mechanical thrombectomy is being considered and this facility is available 7 31. TOF-MRA is limited by its spatial resolution, and, as such, it's depiction of more distal vessel occlusion is inferior to conventional catheter digital subtraction angiography.…”

Patients with acute stroke: Recent developments in neuroimaging

“…It has been validated as a reliable technique in acute stroke [46][47][48] and potentially can be used to stratify patients into different groups, thus affecting patient prognosis and treatment decisions. For example, Kim et al defined three patterns with distinct clinical outcomes.…”