Related Experiment Video

Updated: Jan 31, 2026

Modeling Stroke in Mice: Transient Middle Cerebral Artery Occlusion via the External Carotid Artery
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Modeling Stroke in Mice: Transient Middle Cerebral Artery Occlusion via the External Carotid Artery

Published on: May 24, 2021

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True versus pseudo-occlusion of the cervical internal carotid artery in acute stroke: A multicenter MR angiography

Christian Heitkamp1, Pia Niederau2,3, Arndt-Hendrik Schievelkamp2

  • 1Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

European Stroke Journal
|January 30, 2026
PubMed

Insights

Contrast-enhanced MRA can differentiate true from pseudo-occlusion of the internal carotid artery (ICA) in stroke patients. Experienced radiologists achieve higher accuracy, aiding optimal treatment selection for thrombectomy.

Area of Science:

  • Neurology
  • Radiology
  • Vascular Imaging

Background:

  • Distinguishing true from pseudo-occlusion of the cervical internal carotid artery (ICA) is critical for acute ischemic stroke patients undergoing thrombectomy.
  • Pseudo-occlusion is defined as an isolated intracranial ICA thrombus that suppresses ascending blood flow.

Purpose of the Study:

  • To evaluate the efficacy of contrast-enhanced magnetic resonance angiography (CE-MRA) in differentiating true from pseudo-occlusion of the cervical ICA.
  • To assess the diagnostic performance and inter-reader reliability of CE-MRA in this context.

Main Methods:

  • Retrospective analysis of 41 acute ischemic stroke patients who underwent thrombectomy.
  • CE-MRA images were independently reviewed by six readers (fellows and board-certified radiologists).
  • Reader assessments were compared against digital subtraction angiography (DSA) results.

Main Results:

  • Pseudo-occlusion was present in 39% of patients (16/41).
  • Aggregated sensitivity and specificity for CE-MRA were 72% and 86%, respectively.
  • Board-certified radiologists demonstrated higher accuracy (81% sensitivity, 92% specificity) with substantial inter-reader agreement (κ=0.65).

Conclusions:

  • CE-MRA is a feasible tool for differentiating true from pseudo-ICA occlusion, but requires specialized training and experience.
  • Higher accuracy among experienced radiologists underscores the importance of expertise.
  • Accurate differentiation aids in optimal material selection for endovascular treatment.
Abstract

Keywords:
MR angiographyStrokedigital subtraction angiography%thrombectomy

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