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Gadolinium-Enhanced Extracranial MRA Prior to Mechanical Thrombectomy Is Not Associated With an Improved Procedure

Adrien Guenego1, Naim Khoury2, Raphaël Blanc1

  • 1Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France.

Frontiers in Neurology
|January 29, 2019
PubMed

Insights

Adding extracranial MRA imaging before mechanical thrombectomy (MT) did not significantly alter procedure times or outcomes. This study found no difference in time to recanalization or clinical success when using extracranial MRA in stroke patients.

Area of Science:

  • Neurology
  • Radiology
  • Interventional Cardiology

Background:

  • Mechanical thrombectomy (MT) is a critical intervention for acute ischemic stroke.
  • Optimizing procedural efficiency is key to improving patient outcomes.
  • The role of pre-intervention extracranial imaging in MT workflows requires further investigation.

Purpose of the Study:

  • To evaluate the impact of pre-intervention gadolinium-enhanced extracranial magnetic resonance angiography (MRA) on thrombectomy time metrics.
  • To determine if adding extracranial MRA influences MT speed, efficacy, complications, and clinical outcomes.

Main Methods:

  • Retrospective analysis of 912 patients undergoing MT between 2012 and 2017.
  • Comparison of procedural data between patients with and without pre-intervention extracranial MRA.
  • Multivariate analysis to assess differences in time metrics, recanalization rates, complications, and clinical outcomes.

Main Results:

  • No significant difference was observed in groin puncture to clot contact time or recanalization time between groups.
  • Rates of successful recanalization (mTICI 2b or 3) were similar.
  • Procedural complications and good clinical outcomes (mRS ≤ 2 at 3 months) did not differ significantly.

Conclusions:

  • Pre-intervention gadolinium-enhanced extracranial MRA, in addition to intracranial imaging, does not appear to significantly impact MT procedure times.
  • The addition of extracranial MRA does not seem to delay or shorten thrombectomy procedures.
  • Current evidence suggests no substantial benefit in procedural efficiency or outcomes from routine use of pre-intervention extracranial MRA in MT.
Keywords:
angiogramangiographymagnetic resonance angiographymagnetic resonance imagingrevascularizationstrokethrombectomy

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