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. 2021;15(7):421-428.
doi: 10.5797/jnet.oa.2020-0118. Epub 2021 Jan 6.

Clinical Usefulness of Preoperative MCA Anatomical Scanning MRI in Thrombectomy Therapy for Acute Anterior Circulation Vessel Occlusion

Junko Sato  1 , Sachio Suzuki  1 , Makoto Sasaki  1 , Toshiharu Otaka  1 , Mizuho Aoi  1 , Yuji Uchida  2
Affiliations

Clinical Usefulness of Preoperative MCA Anatomical Scanning MRI in Thrombectomy Therapy for Acute Anterior Circulation Vessel Occlusion

Junko Sato et al. J Neuroendovasc Ther. 2021.

Abstract

Objective: The aim of the present study was to evaluate the usefulness of the T2-weighted three-dimensional sequence method, known as "basi-parallel anatomical scanning (BPAS)-magnetic resonance imaging (MRI)," in demonstrating the running course of the obstructed middle cerebral artery (MCA) before acute mechanical thrombectomy.

Methods: Patients whose M1 part and internal carotid artery (ICA) were occluded on preprocedural MRA, but well demonstrated on MCA anatomical scanning (MAS)-MRI were enrolled in this study. The MAS-MR images for patients in whom thrombectomy was performed were compared with the post-thrombectomy angiography. We compared the running course of the C1-M2 bifurcation on MAS-MRI and angiography after thrombectomy, and the results were classified into 3 groups (Excellent, Good, and Poor).

Results: A total of 13 patients (range: 54-89) were enrolled, among whom 12 underwent thrombectomy. We compared MAS-MRI and post-thrombectomy angiography in 10. On comparison between MAS-MRI and post-procedural angiography, visualization was excellent in six (60%) patients. The mean age was 75.7 years, ranging from 54 to 89, and 6 were males. 3 patients had ICA occlusion and seven had MCA occlusion.

Conclusion: MAS-MRI was considered useful to clarify the running course of the MCA before acute mechanical thrombectomy.

Keywords: MCA anatomical scanning MRI; acute thrombectomy; anterior circulation vessels occlusion.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1. An 82-year-old woman with sudden consciousness disturbance and left hemiparesis. (A) MRA presents right MCA occlusion. (B) The occluded MCA from the proximal to the distal side of the occlusion point can be seen by MAS-MRI. The arrowheads indicate the MCA. (C) 3D image of MAS-MRI shows the occluded MCA from the proximal to the distal area three-dimensionally. The arrowheads indicate the occlusion point. (D) Right internal carotid angiography after thrombectomy. Arrowheads indicate the recanalization point. MAS: MCA anatomical scanning; MCA: middle cerebral artery; MRA: magnetic resonance angiography; MRI: magnetic resonance imaging
Fig. 2
Fig. 2. A 77-year-old-man with repeated left hemiparesis and dysarthria. (A) MRA presents right MCA occlusion. The occlusion point is indicated by the arrowheads on MRA. (B) It is possible to visualize the total occluded M1 (horizontal segment) by MAS-MRI. The occluded MCA can be observed by MAS-MRI. The arrowheads indicate M1 from the proximal side to the distal side of the occlusion point. M1 was steeply descending. Part of the blood vessel wall was in contact with the brain; therefore, the M1 was invisible. (C) Right internal carotid angiography shows M1 occlusion. (D) Right internal carotid angiography shows recanalization of the occluded vessel. (E) MRA after thrombectomy. The arrowheads indicate the recanalization point. MAS: MCA anatomical scanning; MCA: middle cerebral artery; MRA: magnetic resonance angiography; MRI: magnetic resonance imaging
Fig. 3
Fig. 3. An 84-year-old woman with consciousness disturbance. (A) MRA shows occlusions on both sides of the MCA, as indicated by arrowheads. (B) Bifurcation aneurysms on both sides of the MCA can be seen on MAS-MRI. The arrowheads indicate aneurysms. MAS: MCA anatomical scanning; MCA: middle cerebral artery; MRA: magnetic resonance angiography; MRI: magnetic resonance imaging
Fig. 4
Fig. 4. An 89-year-old-man with consciousness disturbance and right hemiparesis. (A) MRA on arrival shows left ICA occlusion. The ICA can be followed until C1. (B) The ICA bifurcation was visualized by MAS-MRI. (C) Left ICA angiography shows ICA occlusion. (D) Left ICA angiography shows recanalization of the occluded vessel. (E) MRA after thrombectomy. ICA: internal carotid artery; MAS: MCA anatomical scanning; MRA: magnetic resonance angiography; MRI: magnetic resonance imaging
Fig. 5
Fig. 5. A 54-year-old-man with consciousness disturbance, left conjugate deviation, and right hemiparesis. (A) MRA on arrival shows right M1 occlusion. (B) MAS-MRI shows part of M1, although it was difficult to visualize in full because part of M1 contacted the brain. (C) Left internal carotid angiography shows M1 occlusion. (D) Left internal carotid angiography shows recanalization of the occluded vessel. (E) MRA after thrombectomy. MAS: MCA anatomical scanning; MRA: magnetic resonance angiography; MRI: magnetic resonance imaging
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