Prediction of occluded-side M1 vessel diameter using pre-procedural magnetic resonance angiography

Area of Science:

• Neuroimaging
• Interventional Neurology
• Vascular Imaging

Background:

• Mechanical thrombectomy is a key treatment for acute ischemic stroke due to M1 occlusion.
• Accurate vessel sizing is crucial for effective aspiration catheter selection during thrombectomy.
• Pre-procedural imaging like magnetic resonance angiography (MRA) is used to assess vessel dimensions.

Purpose of the Study:

• To evaluate if pre-procedural MRA measurements of the M1 vessel diameter can predict the post-procedural digital subtraction angiography (DSA) diameter.
• To assess the utility of this prediction for guiding aspiration catheter selection in mechanical thrombectomy.

Main Methods:

• Retrospective analysis of 41 patients with M1 occlusion undergoing mechanical thrombectomy.
• Comparison of M1 vessel diameters measured on pre-procedural MRA and post-procedural DSA.
• Calculation of catheter-to-vessel ratio (CVR) using pre-procedural MRA measurements and assessment of its correlation with first-pass effect.

Main Results:

• A strong correlation was found between M1 vessel diameter on pre-procedural MRA and post-procedural DSA (r=0.925, R²=0.856).
• The post-procedural DSA diameter can be accurately predicted by adding 0.2 mm to the pre-procedural MRA measurement.
• A first-pass effect was achieved in 66.7% of cases with CVR ≥ 0.80, compared to 25.0% with CVR < 0.80 (p=0.049).

Conclusions:

• Pre-procedural MRA measurements, with an added 0.2 mm, reliably predict the actual M1 vessel diameter for thrombectomy.
• Aspiration catheter selection with a CVR ≥ 0.80 is associated with a higher likelihood of achieving a first-pass effect.
• This imaging-based approach aids in optimizing catheter selection for mechanical thrombectomy in M1 occlusions.