Sarah Power1, Charles Matouk1, Leanne K Casaubon1, Frank L Silver1, Timo Krings1, David J Mikulis1, Daniel M Mandell2. 1. From 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.). 2. From 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.
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.
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