Background: In patients with acute ischemic stroke with the large vessel occlusion (LVO), the presence of low signal including microbleeds on T2*-weighted gradient echo magnetic resonance imaging (T2*-positive) which suggestive of an old cerebral hemorrhage before mechanical thrombectomy (MT) may be associated with hemorrhagic change after MT, but the significance of this finding is unclear. Methods: Patients with acute stroke with LVO underwent T2* before MT. Patients were classified into two groups as T2*-positive and T2*-negative. We compared hemorrhagic change after MT, outcome at discharge and clinical characteristics between two groups. The occurrence of hemorrhagic change was assessed on CT after MT. Patients outcomes were classified into two group; good outcome as modified Rankin Scale (mRS) 0-2 and poor outcome as mRS 5-6, respectively. Clinical characteristics and imaging factors associated with any ICH after MT were evaluated by multivariate regression analysis. Results: 348 patients (median age, 78 years; men, 60.1%; median NIHSS score, 16) were enrolled. The site of occlusion was the ICA (n=92, 26.4%), M1 (n=168, 48.3%), M2 (n=49, 14.1%) and BA(n=29, 8.3%). T2*-positive and T2*-negative were found in 73 (21.0%) and 275 (79.0%), respectively. There were no differences in age, history of hypertension, diabetes, atrial fibrillation and stroke, TOAST type, DWI-ASPECTS, NIHSS, use of tPA, or TICI≧2B rate between the two groups. Any ICH after MT was 28 (38.4%) in T2*-positive and 96 (34.9%) in T2*-negative (P=0.585). PH and SAH were 7 (9.6%) and 2 (2.7%) in T2*-positive and 40 (14.9%) and 25 (9.1%) in T2*-negative (P=0.337, and P=0.085), respectively. Poor outcome was 27 (37.0%) in T2*-positive and 65 (23.6%) in T2*-negative (P=0.025), respectively. Multivariate regression analysis demonstrated that T2*-positive was not associated with any ICH (odds ratio, 0.884; confidence interval, 0.473-1.654; P=0.700). Conclusions: In patients with acute ischemic stroke with LVO, low signal on T2* before MT should not be associated with hemorrhagic change after MT.
Objective: To explain the results of endovascular treatment for unruptured cerebral aneurysms in elderly patients, we divided patients with unruptured cerebral aneurysms who underwent endovascular treatment in our hospital into three groups: elderly (75 years and older), pre-elderly (65–74 years), and young (65 years and younger) groups, and compared the treatment results.
Background and purpose: Reperfusion therapy is typically performed in cases with acute cerebral infarction. Mechanical thrombectomy (MT) achieves superior recanalization and favorable outcomes. However, some patients have poor functional prognosis despite successful recanalization. We investigated factors affecting functional prognosis after MT with good reperfusion. Methods: Among the 205 consecutive cases with ischemic stroke treated with MT at our center from January 1, 2019 to March 31, 2021, 168 with successful recanalization were included. Factors affecting early neurological improvement (ENI) and modified Rankin Scale (mRS) scores were reviewed retrospectively. Results: There were 93 (55%) cases with ENI and 75 (45%) without ENI. The times from onset to recombinant tissue-type plasminogen activator administration and recanalization in ENI cases were shorter than those in non-ENI cases. However, non-ENI cases had significantly higher Fazekas grades for white matter lesions. In multivariate analysis, the Fazekas grade was related to ENI (odds ratio [OR]=0.572, 95% confidence interval [CI]=0.345-0.948). The mRS score at discharge was 0-2 in 64 cases (good outcome) and 3-6 in 104 cases (poor outcome). Patients with a poor outcome had a significantly higher age, National Institutes of Health Stroke Scale (NIHSS) score, and Fazekas grade. Multivariate analysis revealed that the NIHSS score (OR=1.073, 95% CI=1.020-1.129) and Fazekas grade (OR=2.162, 95% CI=1.458-3.205) at hospitalization affected the mRS score at discharge. Conclusion: There is a correlation of greater severity of white matter lesions with poorer ENI and clinical outcomes at discharge post-MT.
Background: Various degrees of thrombosis have been reported in patients with giant aneurysms. However, small, unruptured aneurysms rarely resolve spontaneously. Herein, we report a case of a small unruptured aneurysm in the clinoid segment (C3) of the left internal carotid artery (ICA) that showed almost complete occlusion at the 1-year follow-up. Case Description: A 66-year-old woman developed a subarachnoid hemorrhage on the left side of the perimesencephalic cistern. Cerebral angiography performed on admission revealed no evidence of hemorrhage. Subsequent cerebral angiography on day 12 revealed a dissecting aneurysm on a branch of the superior cerebellar artery (SCA), and the patient underwent parental artery occlusion with 25% n-butyl-2-cyanoacrylate. The postoperative course was uneventful, and the patient was discharged on day 22 with a modified Rankin Scale score of 1. The 1 year follow-up cerebral angiogram demonstrated that the dissecting aneurysm in the SCA branch remained occluded. Notably, a small 2-mm unruptured aneurysm in the clinoid segment (C3) of the left ICA, which was present at the onset of subarachnoid hemorrhage, was almost completely occluded without intervention. Magnetic resonance angiography 1 year after spontaneous resolution of the aneurysm showed no apparent recurrence. Conclusion: This case highlights that even small, unruptured aneurysms can develop spontaneous occlusions.
