Related Experiment Video
Updated: Oct 10, 2025
Simulator Training for Endovascular Neurosurgery
Published on: May 6, 2020
3D Turbo Spin-echo MRI-based Mechanical Thrombectomy at Middle Cerebral Artery Bifurcations
Jiro Ohara1, Motoaki Fujimoto1, Shoichi Tani1
1Department of Neurosurgery, Tenri Hospital.
Abstract:
We describe three cases with acute middle cerebral artery (MCA) occlusion. From the pre-operative MRI, including three-dimensional turbo spin-echo sequences using T1WI and T2WI, we assessed both thrombus configuration and arterial anatomy at the MCA bifurcations. For efficient endovascular thrombectomy, we identified the applied MCA segment 2 (M2) branch, in which the main thrombus was buried. Sufficient recanalization after a single pass was achieved and the patients made a marked recovery. Although mechanical thrombectomy for M2 occlusion has not been of proven benefit, the endovascular procedure based on three-dimensional turbo spin-echo imaging is useful for more complete thrombus removal at MCA bifurcations.
Insights
This study shows 3D MRI can help identify clot location in middle cerebral artery (MCA) occlusions. This aids successful endovascular thrombectomy for better patient recovery.
Area of Science:
- Neurology
- Radiology
- Interventional Neuroradiology
Background:
- Acute middle cerebral artery (MCA) occlusion is a leading cause of severe stroke.
- Endovascular thrombectomy is a critical treatment, but optimal imaging guidance for M2 segment occlusions remains debated.
Purpose of the Study:
- To evaluate the utility of 3D turbo spin-echo MRI sequences in characterizing thrombus and arterial anatomy in MCA bifurcations.
- To assess the effectiveness of image-guided endovascular thrombectomy for M2 segment occlusions.
Main Methods:
- Pre-operative MRI including 3D T1WI and T2WI sequences were used to analyze thrombus configuration and MCA anatomy.
- Identification of the specific M2 branch involved by the main thrombus.
- Performed endovascular thrombectomy guided by pre-operative imaging findings.
Main Results:
- Accurate identification of thrombus location within MCA bifurcations was achieved using 3D MRI.
- Successful recanalization was accomplished in a single pass in all three cases.
- Patients demonstrated significant clinical recovery following the procedure.
Conclusions:
- Three-dimensional turbo spin-echo MRI is valuable for pre-procedural assessment of MCA bifurcations in acute stroke.
- This imaging technique facilitates efficient and complete thrombus removal during endovascular thrombectomy for M2 occlusions.
- The findings suggest a potential benefit of this approach for M2 segment occlusions, despite prior evidence limitations.
