Application Value of Multimodal CT and MRI in Endovascular Treatment of Symptomatic Non-acute Middle Cerebral Artery Occlusion

CUI Huanxi; LIU Ruihua; CUI Hongkai; PEI Guanhui; LI Daoguang; CHEN Song; SUN Guangpu; GU Shili; LI Hao; Ren Jinfa; WANG Mingsheng

doi:10.3969/j.issn.1004-437X.2023.23.004

Abstract：Objective To evaluate the preoperative application of multimodal CT[head and neck CT angiography(CTA)+brain computed tomography perfusion(CTP)]and multimodal MRI[head MRI plain scan+high resolution MRI(HRMRI)]in the intravascular treatment of symptomatic non-acute middle cerebral artery occlusion.Methods The clinical data and endovascular treatment results of 17 patients with symptomatic non-acute middle cerebral artery occlusion admitted to the neurointerventional ward of the First Affiliated Hospital of Xinxiang Medical College from May 2020 to July 2022 were retrospectively analyzed.Seventeen patients underwent head and neck CTA before surgery to evaluate vascular access and collateral circulation.Cerebral CTP was used to evaluate the perfusion status of brain tissue.Head MRI plain scan was used to evaluate the size of the core infarction.HRMRI identifies the cause,length,plaque stability or plaque composition of vascular occlusion,predicts the occlusion time and evaluates the distal vascular bed to guide the formulation of surgical protocols.After surgery,cerebral angiography improved the recovery of blood flow in patients with modified thrombolysis in cerebral infarction scale(mTICI)≥2b level.Craniocerebral CT examination was performed 24 hours after operation to understand the craniocerebral condition.Imaging examination(MRI plain scan,MRA or CTA)was performed within one week to assess whether there was a new cerebral infarction,bleeding,and whether the blood vessels were patency and restenosis.After 90 days of postoperative outpatient follow-up modified Rankin scale score≤2 was classified as good prognosis.Cerebral artery CTA or DSA were used to evaluate the vascular condition 6 to 12 months after surgery.Results The occlusive vessels were successfully opened in all the 17 patients,including balloon dilation in 4 cases and balloon dilation+stent implantation in 13 cases.The stent adhered well to the wall and the blood flow was unobstructed.One patient(5.8％)had a new cerebral infarction,and 15(88.2％)of the 17 patients were followed up 90 days after surgery.The prognosis was good,and no neurological symptoms were aggravated.Imaging follow-up was completed 6 to 12 months after surgery in 15 patients(blood vessels were completely unobstructed in 14 patients,and moderate stenosis occurred in one patient after simple balloon dilation).Conclusion Multi-modal CT and MRI have high diagnostic value in evaluating vascular access,collateral circulation,cerebral tissue perfusion,core infarction,etiology,length and time of occlusion and distal vascular bed of middle cerebral artery occlusion,which is conducive to improving the safety and effectiveness of intravascular therapy for symptomatic middle cerebral artery occlusion.