Comparison of magnetic resonance angiography techniques to brain digital subtraction arteriography in the setting of mechanical thrombectomy: A non-inferiority study - 11/06/22
Highlights |
• | In stroke patients, MR angiography techniques (3D time-of-flight and, contrast-enhanced MR angiography) are inferior to brain digital substraction arteriography in localizing arterial occlusion despite addressing the migratory nature of the thrombus. |
• | Contrast-enhanced MR angiography may be more accurate than 3D time-of-flight MR angiography in localizing arterial occlusion in stroke patients. |
• | Both MR techniques are limited by lower accuracies for tandem occlusions and in assessing proximal internal carotid artery patency. |
Abstract |
Introduction |
We performed a non-inferiority study comparing magnetic resonance angiography (MRA) techniques including contrast-enhanced (CE) and time-of-flight (TOF) with brain digital subtraction arteriography (DSA) in localizing occlusion sites in acute ischemic stroke (AIS) with a prespecified inferiority margin taking into account thrombus migration.
Materials and methods |
HIBISCUS-STROKE (CoHort of Patients to Identify Biological and Imaging markerS of CardiovascUlar Outcomes in Stroke) includes large-vessel-occlusion (LVO) AIS treated with mechanical thrombectomy (MT) following brain magnetic resonance imaging (MRI) including both CE-MRA and TOF-MRA. Locations of arterial occlusions were assessed independently for both MRA techniques and compared to brain DSA findings. Number of patients needed was 48 patients to exclude a difference of more than 20%. Discrepancy factors were assessed using univariate general linear models analysis.
Results |
The study included 151 patients with a mean age of 67.6±15.9years. In all included patients, TOF-MRA and CE-MRA detected arterial occlusions, which were confirmed by brain DSA. For CE-MRA, 38 (25.17%) patients had discordant findings compared with brain DSA and 50 patients (33.11%) with TOF-MRA. The discordance factors were identical for both MRA techniques namely, tandem occlusions (OR=1.29, P=0.004 for CE-MRA and OR=1.61, P<0.001 for TOF-MRA), proximal internal carotid artery occlusions (OR=1.30, P=0.002 for CE-MRA and OR=1.47, P<0.001 for TOF-MRA) and time from MRI to MT (OR=1.01, P=0.01 for CE-MRA and OR=1.01, P=0.02 for TOF-MRA).
Conclusion |
Both MRA techniques are inferior to brain DSA in localizing arterial occlusions in LVO-AIS patients despite addressing the migratory nature of the thrombus.
Le texte complet de cet article est disponible en PDF.Keywords : Stroke, Thrombectomy, Magnetic resonance angiography
Plan
Vol 178 - N° 6
P. 539-545 - juin 2022 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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