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Stroke. 2014 Aug;45(8):2330-4. doi: 10.1161/STROKEAHA.114.005618. Epub 2014 Jun 24.

Vessel wall magnetic resonance imaging in acute ischemic stroke: effects of embolism and mechanical thrombectomy on the arterial wall.

Author information

  • 1From the Division of Neuroradiology, Department of Medical Imaging, University of Toronto and the Toronto Western Hospital, Toronto, Ontario, Canada (S.P., T.K., D.J.M., D.M.M.); Department of Neurosurgery (C.M.) and Department of Diagnostic Radiology (C.M.), Yale University School of Medicine, New Haven, CT; and Division of Neurology, Department of Medicine, University of Toronto and the Toronto Western Hospital, Toronto, Ontario, Canada (L.K.C., F.L.S.).
  • 2From the Division of Neuroradiology, Department of Medical Imaging, University of Toronto and the Toronto Western Hospital, Toronto, Ontario, Canada (S.P., T.K., D.J.M., D.M.M.); Department of Neurosurgery (C.M.) and Department of Diagnostic Radiology (C.M.), Yale University School of Medicine, New Haven, CT; and Division of Neurology, Department of Medicine, University of Toronto and the Toronto Western Hospital, Toronto, Ontario, Canada (L.K.C., F.L.S.). danny.mandell@uhn.ca.

Abstract

BACKGROUND AND PURPOSE:

The aim of the study was to determine the effects of thromboembolism and mechanical thrombectomy on the vessel wall magnetic resonance imaging (VW-MRI) appearance of the intracranial arterial wall.

METHODS:

This was a cross-sectional study of consecutive patients with acute intracranial arterial occlusion who underwent high-resolution contrast-enhanced VW-MRI within days of stroke presentation. For each patient, we categorized arterial wall thickening and enhancement as definite, possible, or none using contralateral arteries as a reference standard. We performed χ(2) tests to compare the effects of medical therapy and mechanical thrombectomy.

RESULTS:

Sixteen patients satisfied inclusion criteria. Median time from symptom onset to VW-MRI was 3 days (interquartile range, 2 days). Among 6 patients treated with mechanical thrombectomy using a stent retriever, VW-MRI demonstrated definite arterial wall thickening in 5 (83%) and possible thickening in 1 (17%); there was definite wall enhancement in 4 (67%) and possible enhancement in 2 (33%). Among 10 patients treated with medical therapy alone, VW-MRI demonstrated definite arterial wall thickening in 3 (30%) and possible thickening in 2 (20%); there was definite wall enhancement in 2 (20%) and possible enhancement in 2 (20%). Arterial wall thickening and enhancement were more common in patients treated with mechanical thrombectomy than with medical therapy alone (P=0.037 and P=0.016, respectively).

CONCLUSIONS:

Mechanical thrombectomy results in intracranial arterial wall thickening and enhancement, potentially mimicking the VW-MRI appearance of primary arteritis. This arterial wall abnormality is less common in patients with arterial occlusion who have been treated with medical therapy alone.

© 2014 American Heart Association, Inc.

KEYWORDS:

infarction; magnetic resonance angiography; magnetic resonance imaging; secondary prevention; stroke; thrombectomy; vasculitis

PMID:
24964050
[PubMed - indexed for MEDLINE]
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