Clinical Usefulness of Preoperative MCA Anatomical Scanning MRI in Thrombectomy Therapy for Acute Anterior Circulation Vessel Occlusion

Objective

The aim of the present study was to evaluate the usefulness of the T2-weighted three-dimensional sequence method, known as "basi-parallel anatomical scanning (BPAS)-magnetic resonance imaging (MRI)," in demonstrating the running course of the obstructed middle cerebral artery (MCA) before acute mechanical thrombectomy.

Methods

Patients whose M1 part and internal carotid artery (ICA) were occluded on preprocedural MRA, but well demonstrated on MCA anatomical scanning (MAS)-MRI were enrolled in this study. The MAS-MR images for patients in whom thrombectomy was performed were compared with the post-thrombectomy angiography. We compared the running course of the C1-M2 bifurcation on MAS-MRI and angiography after thrombectomy, and the results were classified into 3 groups (Excellent, Good, and Poor).

Results

A total of 13 patients (range: 54-89) were enrolled, among whom 12 underwent thrombectomy. We compared MAS-MRI and post-thrombectomy angiography in 10. On comparison between MAS-MRI and post-procedural angiography, visualization was excellent in six (60%) patients. The mean age was 75.7 years, ranging from 54 to 89, and 6 were males. 3 patients had ICA occlusion and seven had MCA occlusion.

Conclusion

MAS-MRI was considered useful to clarify the running course of the MCA before acute mechanical thrombectomy.

Guidelines for the intravenous application of recombinant tissue-type plasminogen activator (alteplase), the second edition, October 2012: a guideline from the Japan Stroke Society

In Japan, intravenous alteplase, a recombinant tissue-type plasminogen activator (rt-PA), was approved for an indication of ischemic stroke in 2005 on the basis of the results of a clinical trial with a unique dose of the drug (0.6 mg/kg). The Japan Stroke Society published the guidelines for intravenous application of rt-PA and organized training sessions for proper use all over Japan in an effort to promote the safe, widespread use of intravenous alteplase. Seven years following its approval, clinical experience with intravenous alteplase has accumulated, additional evidence of intravenous alteplase has been found in Japan and overseas, and the medical environment has substantially changed, including approvals for new drugs and medical devices. Notably, the use of alteplase in the extended therapeutic time window (within 4.5 hours of symptom onset) became covered by insurance in Japan in August 2012. To address these changing situations, we have decided to prepare the revised guidelines. In preparing the second edition, we took care to make its contents more practical by emphasizing information needed in clinical practice. While the first edition was developed with emphasis on safety in light of limited clinical experience with intravenous alteplase in Japan in 2005, this second edition is a substantial revision of the first edition mainly in terms of eligibility criteria, on the basis of accumulated evidence and the clinical experience.