High-resolution magnetic resonance vessel wall imaging–guided endovascular recanalization for nonacute intracranial artery occlusion

View More View Less
  • 1 Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China;
  • | 2 China National Clinical Research Center for Neurological Diseases, Beijing, China;
  • | 3 Tiantan Neuroimaging Center of Excellence, Beijing Tiantan Hospital, Capital Medical University, Beijing, China;
  • | 4 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China;
  • | 5 Department of Radiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China; and
  • | 6 Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, Maryland
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $45.00
USD  $515.00
USD  $612.00
Print or Print + Online Sign in

OBJECTIVE

On the basis of the characteristics of occluded segments on high-resolution magnetic resonance vessel wall imaging (MR-VWI), the authors evaluated the role of high-resolution MR-VWI–guided endovascular recanalization for patients with symptomatic nonacute intracranial artery occlusion (ICAO).

METHODS

Consecutive patients with symptomatic nonacute ICAO that was refractory to aggressive medical treatment were prospectively enrolled and underwent endovascular recanalization. High-resolution MR-VWI was performed before the recanalization intervention. The characteristics of the occluded segments on MR-VWI, including signal intensity, occlusion morphology, occlusion angle, and occlusion length, were evaluated. Technical success was defined as arterial recanalization with modified Thrombolysis in Cerebral Infarction grade 2b or 3 and residual stenosis < 50%. Perioperative complications were recorded. The characteristics of the occluded segments on MR-VWI were compared between the recanalized group and the failure group.

RESULTS

Twenty-five patients with symptomatic nonacute ICAO that was refractory to aggressive medical treatment were consecutively enrolled from April 2020 to February 2021. Technical success was achieved in 19 patients (76.0%). One patient (4.0%) had a nondisabling ischemic stroke during the perioperative period. Multivariable logistic analysis showed that successful recanalization of nonacute ICAO was associated with occlusion with residual lumen (OR 0.057, 95% CI 0.004–0.735, p = 0.028) and shorter occlusion length (OR 0.853, 95% CI 0.737–0.989, p = 0.035).

CONCLUSIONS

The high-resolution MR-VWI modality could be used to guide endovascular recanalization for nonacute ICAO. Occlusion with residual lumen and shorter occlusion length on high-resolution MR-VWI were identified as predictors of technical success of endovascular recanalization for nonacute ICAO.

ABBREVIATIONS

ICAO = intracranial artery occlusion; IQR = interquartile range; MR-VWI = magnetic resonance vessel wall imaging; TICI = Thrombolysis in Cerebral Infarction.

Supplementary Materials

    • Supplemental Table 1 (PDF 415 KB)

Images from Minchev et al. (pp 479–488).

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $515.00
USD  $612.00
  • 1

    Gorelick PB, Wong KS, Bae HJ, Pandey DK. Large artery intracranial occlusive disease: a large worldwide burden but a relatively neglected frontier. Stroke. 2008;39(8):23962399.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Wong LK. Global burden of intracranial atherosclerosis. Int J Stroke. 2006;1(3):158159.

  • 3

    Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):17231731.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Yamauchi H, Higashi T, Kagawa S, Kishibe Y, Takahashi M. Chronic hemodynamic compromise and cerebral ischemic events in asymptomatic or remote symptomatic large-artery intracranial occlusive disease. AJNR Am J Neuroradiol. 2013;34(9):17041710.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Kuroda S, Houkin K, Kamiyama H, Mitsumori K, Iwasaki Y, Abe H. Long-term prognosis of medically treated patients with internal carotid or middle cerebral artery occlusion: can acetazolamide test predict it? Stroke. 2001;32(9):21102116.

    • Search Google Scholar
    • Export Citation
  • 6

    Gao F, Guo X, Han J, Sun X, Zhuo Z, Miao Z. Endovascular recanalization for symptomatic non-acute middle cerebral artery occlusion: proposal of a new angiographic classification. J Neurointerv Surg. 2021;13(10):900905.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Gao F, Guo X, Sun X, Liu Y, Wu Y, Miao Z. Dual-roadmap guidance for endovascular recanalization of medically refractory non-acute intracranial arterial occlusions: consecutive multicenter series and technical review. J Neurointerv Surg. 2021;13(10):889893.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Gao F, Sun X, Guo X, Li D, Xu GD, Miao ZR. Endovascular recanalization of symptomatic nonacute intracranial internal carotid artery occlusion: proposal of a new angiographic classification. AJNR Am J Neuroradiol. 2021;42(2):299305.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Gao F, Sun X, Zhang H, Ma N, Mo D, Miao Z. Endovascular recanalization for nonacute intracranial vertebral artery occlusion according to a new classification. Stroke. 2020;51(11):33403343.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Yao YD, Liu AF, Qiu HC, Zhou J, Li C, Wang Q, et al. Outcomes of late endovascular recanalization for symptomatic non-acute atherosclerotic intracranial large artery occlusion. Clin Neurol Neurosurg. 2019;187:105567.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Ma L, Liu YH, Feng H, Xu JC, Yan S, Han HJ, et al. Endovascular recanalization for symptomatic subacute and chronic intracranial large artery occlusion of the anterior circulation: initial experience and technical considerations. Neuroradiology. 2019;61(7):833842.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    PH, Park JW, Park S, Kim JL, Lee DH, Kwon SU, et al. Intracranial stenting of subacute symptomatic atherosclerotic occlusion versus stenosis. Stroke. 2011;42(12):34703476.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Chen YH, Leong WS, Lin MS, Huang CC, Hung CS, Li HY, et al. Predictors for successful endovascular intervention in chronic carotid artery total occlusion. JACC Cardiovasc Interv. 2016;9(17):18251832.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Alexander MJ, Zauner A, Chaloupka JC, Baxter B, Callison RC, Gupta R, et al. WEAVE trial: final results in 152 on-label patients. Stroke. 2019;50(4):889894.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Chimowitz MI, Lynn MJ, Derdeyn CP, Turan TN, Fiorella D, Lane BF, et al. Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med. 2011;365(11):9931003.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Gao P, Wang Y, Ma Y, Yang Q, Song H, Chen Y, et al. Endovascular recanalization for chronic symptomatic intracranial vertebral artery total occlusion: experience of a single center and review of literature. J Neuroradiol. 2018;45(5):295304.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    He Y, Bai W, Li T, Xue J, Wang Z, Zhu L, Hui F. Perioperative complications of recanalization and stenting for symptomatic nonacute vertebrobasilar artery occlusion. Ann Vasc Surg. 2014;28(2):386393.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Yang Y, Liu X, Wang R, Zhang Y, Zhang D, Zhao J. A treatment option for symptomatic chronic complete internal carotid artery occlusion: hybrid surgery. Front Neurosci. 2020;14 392.

    • PubMed
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 1461 1461 207
Full Text Views 143 143 34
PDF Downloads 219 219 64
EPUB Downloads 0 0 0