Contrast-enhanced high-resolution magnetic resonance imaging for predicting recanalization in non-acute middle cerebral artery occlusion

Abstract

The potential predictive value of contrast-enhanced high-resolution magnetic resonance-vessel wall imaging (MR-VWI) for endovascular recanalization in patients with non-acute middle cerebral artery (MCA) occlusion remains unclear. We retrospectively enrolled consecutive patients with non-acute symptomatic MCA occlusion who underwent endovascular recanalization. High-resolution MR-VWI scans were performed prior to recanalization. Then, we evaluated specific imaging characteristics of the occluded segments, including the site, length, angulation, and collateral vessel classification. Technical success was defined as revascularization with a modified Thrombolysis in Cerebral Infarction (mTICI) grade of 2b or 3 and residual stenosis < 50%. The imaging characteristics of the successful and failed-recanalization groups were compared. Thirty-nine patients with recurrent non-acute MCA occlusion refractory to aggressive pharmacological therapy were enrolled between August 2022 and January 2024. Recanalization was successfully achieved in 29 patients. Multivariable logistic analysis showed that MR-VWI hyperintensity was associated with successful recanalization (odds ratio [OR]: 17.98; 95% confidence interval [CI]: CI 1.869–172.992, p = 0.012). In contrast, the presence of dissection was associated with recanalization failure (OR: 0.03; 95% CI: 0.002–0.652, p = 0.025). MR-VWI indicates that hyperintensity and the absence of vascular dissection in the occluded segment may be associated with recanalization.