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Utilizing a Cranial Window to Visualize the Middle Cerebral Artery During Endothelin-1 Induced Middle Cerebral Artery Occlusion
Published on: February 22, 2013
Use of Middle Cerebral Artery Visualization with Coronal Computed Tomography to Access Target Artery in Mechanical
Yuichiro Ohya1, Takeshi Uwatoko1, Taichiro Mizokami2
1Department of Cerebrovascular Medicine, Saga-ken Medical Centre Koseikan, Saga, Japan.
Background:
When introducing a microguidewire into an occluded vessel during mechanical thrombectomy (MT), visual information on the vessel course distal to the occluded site could help to avoid perforation. We examined whether visualization of the middle cerebral artery (MCA) by coronal images of nonenhanced computed tomography (coronal CT) provides useful preoperative information on the vessel course in the setting of MT.
Methods And Results:
We retrospectively studied 29 patients with ischemic stroke of the internal carotid artery and MCA occlusion who were admitted to our hospital within 4.5 hours from stroke onset and underwent MT. Coronal CT images were preoperatively created by a dedicated workstation and adjusted to visualize the M1 segment of the MCA (M1) and nearby areas. We referred to these images while performing MT. The shape and course of M1 on preoperative coronal CT images were compared with that in intraoperative angiography after recanalization. The median time from the start of imaging to arterial puncture was 40 minutes (interquartile range: 32.5-55.0 minutes). Successful recanalization of the thrombolysis in cerebral infarction 2b-3 was achieved in 89.7% of patients. The degree of matching was assessed as moderate to excellent, and was useful as preoperative information in 27 (93.1%) patients.
Conclusions:
Preoperative information on the vessel course by coronal CT well matched that in the intraoperative angiography. Only a little extra time and a small additional procedure are necessary for this technique. The addition of coronal CT images could contribute to a safe and successful MT.
Insights
Coronal CT imaging provides valuable preoperative information on the middle cerebral artery (MCA) vessel course, aiding in safe and successful mechanical thrombectomy (MT) for ischemic stroke patients. This technique enhances procedural accuracy and patient outcomes.
Area of Science:
- Neurology
- Radiology
- Interventional Neuroradiology
Background:
- Mechanical thrombectomy (MT) for ischemic stroke requires precise microguidewire navigation.
- Perforation risk during MT can be mitigated by visualizing the vessel course distal to occlusion.
- Nonenhanced computed tomography (CT) coronal images may offer crucial preoperative insights.
Purpose of the Study:
- To evaluate the utility of coronal CT visualization of the middle cerebral artery (MCA) for preoperative guidance in MT.
- To determine if coronal CT accurately depicts the MCA vessel course before MT procedures.
Main Methods:
- Retrospective study of 29 ischemic stroke patients with MCA occlusion undergoing MT.
- Preoperative coronal CT images were generated to visualize the M1 segment of the MCA.
- Coronal CT findings were compared with intraoperative angiography post-recanalization.
Main Results:
- Successful recanalization (Thrombolysis in Cerebral Infarction 2b-3) achieved in 89.7% of patients.
- Preoperative coronal CT accurately matched intraoperative angiography in 93.1% of cases (moderate to excellent agreement).
- The imaging technique added minimal time (median 40 minutes from imaging to puncture).
Conclusions:
- Coronal CT provides reliable preoperative information on MCA anatomy for MT.
- This technique is efficient, requiring minimal extra time and procedure.
- Incorporating coronal CT images can enhance the safety and success rates of mechanical thrombectomy.
