Improved preoperative planning for endovascular therapy: High-resolution vessel wall magnetic resonance imaging shows promise in identifying proximal occlusion site and distal boundary of the occlusion of acute ischemic stroke.

Abstract

Background and purpose: Detecting the proximal occlusion site (POS) and distal boundary of the occlusion (DBO) of arterial occlusion is very important for the prognosis of endovascular treatment. Recent studies have shown that magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) are also beneficial for preoperative patient selection for endovascular therapy. High-resolution vessel wall MRI (HRVW-MRI) for intraluminal detection of arterial largevessel occlusions (LVOs) is receiving increasing attention. The purpose of this study was to evaluate the diagnostic efficacy of HRVW-MRI for POS and DBO.

Materials and methods: The data of 42 patients with acute anterior circulation cerebral infarction were retrospectively analyzed. By comparing with digital subtraction angiography (DSA), the POS and DBO were analyzed to determine the efficacy of HRVW-MRI for LVO location.

Results: Good to excellent interobserver consistency was achieved in the analysis and evaluation of all image data (k > 0.70). There was better concordance for the POS between HRMRI and DSA than that between MRA and DSA (k = 0.834 vs. k = 0.309). Compared with DSA, HRVW-MRI showed an advantage over DSA in terms of clearly determining DBO (χ² = 9.389, P < 0.01).

Conclusion: HRVW-MRI demonstrated a comparative advantage over Time-of-flight-MRA for differentiating the POS, with accuracy near-equivalent to that of DSA and a clear advantage over DSA for DBO detection. HRVW-MRI has the potential to improve preoperative planning for endovascular therapy.