CS-VIBE accelerates cranial nerve MR imaging for the diagnosis of facial neuritis: comparison of the diagnostic performance of post-contrast MPRAGE and CS-VIBE.

OBJECTIVE: We aimed to compare the diagnostic performance of post-contrast 3D compressed sensing volume-interpolated breath-hold examination (CS-VIBE) and 3D T1 magnetization-prepared rapid-acquisition gradient-echo (MPRAGE) in detecting facial neuritis. MATERIALS AND METHODS: Between February 2019 and September 2019, 60 patients (30 facial palsy patients and 30 controls) who underwent contrast-enhanced cranial nerve MRI with both conventional MPRAGE and CS-VIBE (scan time: 6 min 8 s vs. 2 min 48 s) were included in this retrospective study. All images were independently reviewed by three radiologists for the presence of facial neuritis. In patients with facial palsy, signal-to-noise ratio (SNR) of the pons, enhancement degree and contrast-to-noise ratio (CNRnerve-CSF) of the facial nerve were measured. The overall image quality, artifacts, and facial nerve discrimination were analyzed. The sensitivity and specificity of both sequences were calculated with the clinical diagnosis as a reference. RESULTS: CS-VIBE had comparable performance in the detection of facial neuritis to that of MPRAGE (sensitivity and specificity, 97.8% and 99.4% vs. 100.0% and 99.4% in pooled analysis; 97.8% and 98.9% vs. 100.0% and 98.9% in patents with facial palsy, p value > 0.05 for all). CS-VIBE showed significantly lower SNR (p value < 0.001 for all), but significantly higher CNRnerve-CSF (p value < 0.05 for all) than MPRAGE. CS-VIBE also performed better in the overall image quality, artifacts, and facial nerve discrimination than MPRAGE (p value < 0.001 for all). CONCLUSION: CS-VIBE achieved comparable diagnostic performance for facial neuritis compared to the conventional MPRAGE, with the scan time being half of that of MPRAGE. KEY POINTS: • Post-contrast 3D CS-VIBE MRI is a reliable method for the diagnosis of facial neuritis. • CS-VIBE reduces the scan time of cranial nerve MRI by more than half compared to conventional T1-weighted image. • CS-VIBE had better performance in contrast-to-noise ratio and favorable image quality compared with conventional T1-weighted image.

Wave-CAIPI susceptibility-weighted imaging achieves diagnostic performance comparable to conventional susceptibility-weighted imaging in half the scan time.

OBJECTIVES: We aimed to evaluate the agreement in the detection of cerebral microbleeds (CMBs) between conventional susceptibility-weighted imaging (SWI) and fast SWI using wave-controlled aliasing in parallel imaging (CAIPI) acceleration. We also scrutinized the diagnostic agreement for intracranial lesions and compared the image quality between both sequences. METHODS: Institutional review board approval was obtained and informed consent was waived for this retrospective study. We included 181 consecutive patients who had undergone brain MRI with both conventional SWI (scan time, 251 s) and wave-CAIPI SWI (scan time, 113 s) from September 2017 to November 2017. All images were independently reviewed by two radiologists for the detection and counting of CMBs using the Microbleed Anatomical Rating Scale (MARS). One neuroradiologist diagnosed intracranial lesions and scored image quality using visual analysis. The agreement for detection of CMBs and intracranial lesions was calculated, and interobserver agreements were analyzed by using kappa and intraclass correlation. RESULTS: For detection of CMBs, both the conventional and wave-CAIPI SWI showed significantly high agreement of 100% for the presence of CMBs, and 94.5% using MARS. Wave-CAIPI SWI achieved more than 97% agreement of MARS when divided by anatomical locations, with excellent agreement. Interobserver agreements were also excellent. The diagnosis for intracranial lesions (33 lesions in 28 patients) demonstrated 100% agreement. The image quality of both sequences is not significantly different (p = 0.20). CONCLUSIONS: Wave-CAIPI SWI achieved high agreement for CMB detection and diagnosis of intracranial lesions compared to conventional SWI within half of the scan time. KEY POINTS: • Wave-CAIPI SWI achieves a diagnostic performance for the detection of cerebral microbleeds that is comparable to that of conventional SWI in half the scan time. • Interobserver agreement for the detection (presence vs. absence) and counting of cerebral microbleeds of wave-CAIPI SWI was excellent. • Wave-CAIPI SWI demonstrated a 100% agreement for the diagnosis of intracranial lesions and comparable image quality compared to conventional SWI.

Image-guided delayed recanalization of middle cerebral artery occlusion.

Recent advance in devices, techniques, and peri-procedural patient management in the conduct of mechanical thrombectomy enables neuro-interventionists to recanalize occluded cerebral arteries with greater efficiency and safety than ever. It is conceivable that there exist a group of stroke patients who would benefit from recanalization beyond 24-h time window following the onset of symptom, if viable brain tissue remains at that time. We report a case of a 56-year-old patient who received mechanical thrombectomy 96 h after the onset of symptoms by diffusion/perfusion imaging. The application of advanced neuroimaging and analytical software can accurately estimate viable brain tissue, which enables clinicians to implement individualized therapeutic strategies for patients with acute stroke.

Hypersensitivity Reactions to Iodinated Contrast Media: A Multicenter Study of 196 081 Patients.

Background Multicenter studies may be required for establishing guidelines for safe usage of iodinated contrast media (ICM). Purpose To identify the prevalence, patterns, risk factors, and preventive measures for ICM-related hypersensitivity reactions (HSRs). Materials and Methods Between March 2017 and October 2017, a total of 196 081 patients who underwent ICM administration were enrolled from seven participating institutions. The occurrence of HSRs and baseline patient information were recorded. χ2 and Student t test were performed, and logistic regression analyses were used to identify risk factors that predict occurrence and recurrence of HSR. Results Among 196 081 patients (mean age ± standard deviation, 59.1 years ± 16.0; 105 014 men and 91 067 women) who underwent ICM administration, the overall prevalence of HSRs was 0.73% (1433 of 196 081), and severe reactions occurred in 0.01% (17 of 196 081). Conditional logistic regression for patients with HSR (n = 1433) and a control group (1:1 matched group for age, sex, ICM product, and institution) demonstrated that a patient's previous individual history of an ICM-related HSR (adjusted odds ratio [OR], 198.8; P < .001), hyperthyroidism (adjusted OR, 3.6; P = .04), drug allergy (adjusted OR, 3.5; P < .001), and other allergic diseases (adjusted OR, 6.8; P < .001) and a family history of ICM-related HSRs (adjusted OR, 14.0; P = .01) were predictors of HSR occurrence. Logistic regression analysis showed that use of premedication with antihistamine (OR, 0.5; P = .01) and change in the generic profile of ICM (OR, 0.5; P < .001) were preventive against recurrent HSR. Conclusion Family history as well as previous individual history of hypersensitivity reactions (HSRs) to iodinated contrast media (ICM) were risk factors for HSR occurrence, suggesting a potential genetic predisposition. A change in the culprit ICM and premedication with antihistamine are useful for reducing the recurrence of HSRs. © RSNA, 2019 Online supplemental material is available for this article.

Number of Stent Retriever Passes Associated With Futile Recanalization in Acute Stroke.

Background and Purpose- Stent retriever (SR) thrombectomy has become the mainstay of treatment of acute intracranial large artery occlusion. However, it is still not much known about the optimal limit of SR attempts for favorable outcome. We evaluated whether a specific number of SR passes for futile recanalization can be determined. Methods- Patients who were treated with a SR as the first endovascular modality for their intracranial large artery occlusion in anterior circulation were retrospectively reviewed. The recanalization rate for each SR pass was calculated. The association between the number of SR passes and a patient's functional outcome was analyzed. Results- A total of 467 patients were included. Successful recanalization by SR alone was achieved in 82.2% of patients. Recanalization rates got sequentially lower as the number of passes increased, and the recanalization rate achievable by ≥5 passes of the SR was 5.5%. In a multivariable analysis, functional outcomes were more favorable in patients with 1 to 4 passes of the SR than in patients without recanalization (odds ratio [OR] was 8.06 for 1 pass; OR 7.78 for 2 passes; OR 6.10 for 3 passes; OR 6.57 for 4 passes; all P<0.001). However, the functional outcomes of patients with ≥5 passes were not significantly more favorable than found among patients without recanalization (OR 1.70 with 95% CI, 0.42-6.90 for 5 passes, P=0.455; OR 0.33 with 0.02-5.70, P=0.445 for ≥6 passes). Conclusions- The likelihood of successful recanalization got sequentially lower as the number of SR passes increased. Five or more passes of the SR became futile in terms of the recanalization rate and functional outcomes.

Rescue Stenting for Failed Mechanical Thrombectomy in Acute Ischemic Stroke: A Multicenter Experience.

BACKGROUND AND PURPOSE: Effective rescue treatment has not yet been suggested in patients with mechanical thrombectomy (MT) failure. This study aimed to test whether rescue stenting (RS) improved clinical outcomes in MT-failed patients. METHODS: This is a retrospective analysis of the cohorts of the 16 comprehensive stroke centers between September 2010 and December 2015. We identified the patients who underwent MT but failed to recanalize intracranial internal carotid artery or middle cerebral artery M1 occlusion. Patients were dichotomized into 2 groups: patients with RS and without RS after MT failure. Clinical and laboratory findings and outcomes were compared between the 2 groups. It was tested whether RS is associated with functional outcome. RESULTS: MT failed in 148 (25.0%) of the 591 patients with internal carotid artery or middle cerebral artery M1 occlusion. Of these 148 patients, 48 received RS (RS group) and 100 were left without further treatment (no stenting group). Recanalization was successful in 64.6% (31 of 48 patients) of RS group. Compared with no stenting group, RS group showed a significantly higher rate of good outcome (modified Rankin Scale score, 0-2; 39.6% versus 22.0%; P=0.031) without increasing symptomatic intracranial hemorrhage (16.7% versus 20.0%; P=0.823) or mortality (12.5% versus 19.0%; P=0.360). Of the RS group, patients who had recanalization success had 54.8% of good outcome, which is comparable to that (55.4%) of recanalization success group with MT. RS remained independently associated with good outcome after adjustment of other factors (odds ratio, 3.393; 95% confidence interval, 1.192-9.655; P=0.022). Follow-up vascular imaging was available in the 23 (74.2%) of 31 patients with recanalization success with RS. The stent was patent in 20 (87.0%) of the 23 patients. Glycoprotein IIb/IIIa inhibitor was significantly associated with stent patency but not with symptomatic intracranial hemorrhage. CONCLUSIONS: RS was independently associated with good outcomes without increasing symptomatic intracranial hemorrhage or mortality. RS seemed considered in MT-failed internal carotid artery or middle cerebral artery M1 occlusion.

Collateral status affects the onset-to-reperfusion time window for good outcome.

OBJECTIVE: To characterise the time window in which endovascular thrombectomy (EVT) is associated with good outcome, and to test the differential relationship between functional outcome and onset-to-reperfusion time (ORT), depending on collateral status. METHODS: This was a retrospective analysis of clinical and imaging data of 554 consecutive patients, who had recanalisation success by EVT for anterior circulation large artery occlusion, from the prospectively maintained registries of 16 comprehensive stroke centres between September 2010 and December 2015. The patients were dichotomised into good and poor collateral groups, based on CT angiography. We tested whether the likelihood of good outcome (modified Rankin Scale, 0-2) by ORT was different between two groups. RESULTS: ORT was 298 min±113 min (range, 81-665 min), and 84.5% of patients had good collaterals. Age, diabetes mellitus, previous infarction, National Institutes of Health Stroke Scale, good collaterals (OR 40.766; 95% CI 10.668 to 155.78; p<0.001) and ORT (OR 0.926 every 30 min delay; 95% CI 0.862 to 0.995; p=0.037) were independently associated with good outcome. The drop in likelihood of good outcome associated with longer ORT was significantly faster in poor collateral group (OR 0.305 for every 30 min; 95% CI 0.113 to 0.822) than in good collateral group (OR 0.926 for every 30 min; 95% CI 0.875 to 0.980). CONCLUSIONS: Earlier successful recanalisation was strongly associated with good outcome in poor collateral group; however, this association was weak during the tested time window in good collateral group. This suggests that the ORT window for good outcome can be adjusted according to collateral status.

Relationships between eyelid position and levator-superior rectus complex and inferior rectus muscle in patients with Graves' orbitopathy with unilateral upper eyelid retraction.

PURPOSE: To assess the relationships between eyelid position and levator palpebrae superioris (LPS)-superior rectus (SR) complex and inferior rectus (IR) muscle volume in patients with Graves' orbitopathy (GO) with unilateral upper eyelid retraction. METHODS: This was a cross-sectional observational study of 48 patients with GO with unilateral upper eyelid retraction. To measure muscle volume, computerized tomography scans were performed, and 3D images were analyzed. Digital photographs were taken, and vertical eyelid height was measured using computed eyelid analysis software. The measured muscle volumes and eyelid heights were assessed, and correlation analysis was performed. To verify the parameters that are predictive for the presence of upper eyelid retraction, receiver operating characteristic curves were analyzed, and logistic regression was performed. RESULTS: The volume of the LPS/SR muscle complex in the eyes with upper eyelid retraction was increased in 41 eyes (85.4%). The mean volume of the LPS/SR complex was 0.92 ± 0.40 cm3 in the eyes with upper eyelid retraction and 0.72 ± 0.27 cm3 in the contralateral eyes (p < 0.0001). While there was no correlation between LPS/SR complex volume and margin reflex distance1 (MRD1, the vertical distance between the center of the pupil to the center of the upper eyelid margin) (R = 0.024, p = 0.869), MRD1 and MRD2 (the vertical distance between the center of the pupil and the center of the lower eyelid margin) in the retracted eyes were negatively correlated (R = - 0.441, p = 0.002). In patients with upper eyelid retraction without increased LPS/SR complex volume, IR volume and MRD2 of the contralateral eye were 0.48 ± 0.10 cm3 and 5.92 ± 0.45 mm, respectively. In the retracted eye, they were 0.37 ± 0.17 cm3 and 5.32 ± 0.59 mm, respectively (p = 0.018, and 0.028). Regression models incorporating LPS/SR complex volume, MRD1, and lid lag could predict the presence of upper eyelid retraction with an accuracy of 92.5%. CONCLUSIONS: In patients with GO, increased LPS/SR complex volume in the retracted eye and increased IR volume of the contralateral eye were both associated with unilateral upper eyelid retraction. The combination of LPS/SR complex volume, MRD1, and lid lag can be used as a reliable index of upper eyelid retraction in patients with GO.

Quantitative analysis of orbital soft tissues on computed tomography to assess the activity of thyroid-associated orbitopathy.

PURPOSE: To evaluate the validity of using quantitative volume and density measurements from orbital computed tomography (CT) images to assess the inflammatory activity of patients with thyroid-associated orbitopathy (TAO). METHODS: Computed tomography (CT) scans were obtained from 80 TAO patients and 40 controls, and 3D image analysis was conducted to measure the volume and density (in HU units) of intraorbital and extraorbital fat, extraocular muscle (EOM), and the lacrimal gland. Volume and density measurements of the orbital tissues were compared among active TAO, inactive TAO, and control subjects by ANCOVA. To determine the predictive value of each parameter for TAO activity, logistic regression was performed. RESULTS: The mean volume of extraorbital and intraorbital fat was significantly higher in patients with TAO than controls (p = 0.0019, p = 0.0004), with no significant difference between active and inactive TAO subjects. The mean total EOM volume and lacrimal gland volume was greater in active TAO patients than other groups (p < 0.0001, p < 0.0001). The mean density of extraorbital fat and the lacrimal gland was significantly different between active TAO, inactive TAO, and control groups (p = 0.0002, and p = 0.0487, respectively). Regression models incorporating total EOM volume, lacrimal gland volume, intraorbital fat volume, and density of extraorbital fat and the lacrimal gland could predict active inflammation in patients with TAO with accuracy of 84.5 %. CONCLUSIONS: The measurements of orbital soft tissue volume and density using CT scans can be used as a reliable and feasible technique to establish active inflammation in patients with TAO.

Mechanical thrombectomy in cardiac myxoma stroke: a case report and review of the literature.

Cardiac myxoma is the most common primary tumor of the heart. It is a rare cause of acute ischemic stroke and commonly not detected until after the stroke. There is no current guideline for the treatment of cardiac myxoma stroke and only a few cases of mechanical thrombectomy have been reported. We present a case of cardiac myxoma stroke in a 4-year-old boy treated with a stent-retrieval device and review the literature describing the safety and efficacy of mechanical thrombectomy in cardiac myxoma stroke. We also describe imaging features of the myxoma clot on susceptibility weighted images.

Imaging characteristics of sinonasal organized hematoma.

BACKGROUND: Sinonasal organized hematoma is a rare benign disease that may be mistaken for malignancy. PURPOSE: To define the imaging characteristics of sinonasal organized hematoma. MATERIAL AND METHODS: We retrospectively reviewed computed tomography (CT) images of eight patients (4 male patients, 4 female patients; mean age, 40 years; range, 9-83 years) with pathologically proven sinonasal organized hematomas; magnetic resonance imaging (MRI) was performed in one patient among them. The following lesions characteristics were analyzed: size, shape, location, expansile nature, density, signal intensity, internal structure, enhancement pattern, and surrounding bony wall change. RESULTS: The lesion sizes were in the range of 2-5.2 cm (mean, 3.55 cm), and the shapes were lobular, lumpy, or nodular. They were located in the nasal cavity (n = 1), maxillary sinuses (n = 2), or both nasal cavities and maxillary sinuses (n = 5). Expansile lesions with locally aggressive margins were observed in two cases. All lesions were hyperdense on precontrast CT scans; the smaller lesions showed even hyperdensity, whereas the larger lesions showed uneven density. The signal intensity was mixed on MRI, consisting of hemorrhage, fibrosis, and neovascularization. Papillary or frond-like enhancement was noted after contrast injection. All cases showed smooth erosion of the medial walls of the maxillary sinuses, and the epicenters were the secondary maxillary ostia. Two lesions showed erosion of the lateral walls of the maxillary sinuses and were expansile in nature. Non-hemorrhagic polyps accompanied the organized hematomas in three cases. CONCLUSION: Although sinonasal organized hematoma can be mistaken for a malignant tumor, the following characteristic imaging findings facilitate the diagnosis of an organized hematoma: erosion of the bony sinus walls, markedly heterogeneous signal intensity, and papillary or frond-like enhancement.

Wave-controlled aliasing in parallel imaging (Wave-CAIPI): Accelerating speed for the MRI-based diagnosis of enhancing intracranial lesions compared to magnetization-prepared gradient echo.

PURPOSE: We aimed to validate the diagnostic performance of accelerated post-contrast magnetization-prepared rapid gradient-echo (MPRAGE) using wave-controlled aliasing in parallel imaging (Wave-CAIPI) for enhancing intracranial lesions, compared with conventional MPRAGE. METHODS: A total of 233 consecutive patients who underwent post-contrast Wave-CAIPI and conventional MPRAGE (scan time: 2 min 39 s vs. 4 min 30 s) were retrospectively evaluated. Two radiologists independently assessed whole images for the presence and diagnosis of enhancing lesions. The diagnostic performance for non-enhancing lesions, quantitative parameters (diameter of enhancing lesions, signal-to-noise ratio [SNR], contrast-to-noise ratio [CNR], and contrast rate), qualitative parameters (grey-white matter differentiation and conspicuity of enhancing lesions), and image qualities (overall image quality and motion artifacts) were also surveyed. The weighted kappa and percent agreement were used to evaluate the diagnostic agreement between the two sequences. RESULTS: Wave-CAIPI MPRAGE achieved significantly high agreement for the detection (98.7%[460/466], κ = 0.965) and diagnosis (97.8%[455/466], κ = 0.955) of enhancing intracranial lesions with conventional MPRAGE in pooled analysis. Detection and diagnosis of non-enhancing lesions (97.6% and 96.9% agreement), and diameter of enhancing lesions (P>0.05) also demonstrated high agreements between two sequences. Although Wave-CAIPI MPRAGE show lower SNR (P<0.01) than conventional MRAGE, it fulfilled comparable CNR (P = 0.486) and higher contrast rate (P<0.01). The qualitative parameters show similar value (P>0.05). The overall image quality was slightly poor, however, motion artifacts were better in Wave-CAIPI MPRAGE (both P = 0.005). CONCLUSION: Wave-CAIPI MPRAGE provides reliable diagnostic performance for enhancing intracranial lesions within half of the scan time compared with conventional MPRAGE.

Asymptomatic Common Carotid Artery Occlusion and Occipital-Vertebral Artery Anastomosis: A Case Report and Literature Review.

Common carotid artery occlusion (CCAO) is a very rare disorder that has rarely been studied. CCAO causes several neurological symptoms but can sometimes be asymptomatic due to the development of various anastomoses. Herein, we report the case of a 70-year-old male patient diagnosed with asymptomatic CCAO due to anastomotic flow. The patient underwent transfemoral cerebral angiography (TFCA) and was found to have CCAO with two collateral pathways, including an occipital artery-vertebral artery anastomosis. We emphasize the importance of TFCA when CCAO is suspected and review the types and anastomotic pathways of CCAO.

Safety and Efficacy of Low-dose Prasugrel in the Endovascular Treatment of Unruptured Aneurysms in the Elders (≥ 75 Years).

PURPOSE: The effectiveness and safety of low-dose prasugrel (PSG) premedication for endovascular treatment of unruptured intracranial aneurysms (UIAs) have been widely reported. In this study, we evaluated the clinical outcomes of elders patients (≥ 75 years) treated with PSG. METHODS: A total of 200 patients with 209 UIAs who were administered PSG as premedication (20 mg loading and 5 mg maintenance with 100 mg aspirin) between March 2018 and December 2021 were retrospectively enrolled. Among them, 39 patients were aged 75 years or over (elders group), and 161 patients were aged under 75 years (control group). Patients' clinical data were collected, and outcomes were compared between the two groups. RESULTS: Of the 200 patients with PSG, 9 cases (4.5%) had overall complications (7 ischemic, 2 hemorrhagic). In the comparison between the elders group and the control group, no significant differences were observed in the overall complication rates (elders group vs. control group; 2.6% vs. 5.0%, P = 1.00). Moreover, the rates of poor clinical outcome were comparable (2.6% vs. 1.2%, P = 0.48). The subgroup analysis of patients with stent-assisted procedures revealed no significant differences in complication rates (0% vs. 1.6%, P = 1.00) or poor clinical outcomes (0% vs. 0%, P = 1.00) during maintenance with aspirin 100 mg or PSG 5 mg. CONCLUSION: The complication rates in the elders treated with low-dose PSG premedication were similar to those in the control. Low-dose PSG premedication could be prescribed without any additional risk for the endovascular treatment of UIAs in elders patients.

Diagnosis of intracranial lesions using accelerated 3D T1 MPRAGE with wave-CAIPI technique: comparison with conventional 3D T1 MPRAGE.

We aimed to evaluate the agreement in the diagnosis of intracranial lesions between conventional pre-contrast 3D T1 magnetization-prepared rapid gradient echo (MPRAGE) and wave-CAIPI (wave-controlled aliasing in parallel imaging) MPRAGE. Institutional review board approval was obtained and informed consent was waived for this retrospective study. We included 149 consecutive patients who had undergone brain MR with both conventional MPRAGE (scan time: 5 min 42 s) and wave-CAIPI MPRAGE (scan time: 2 min 44 s) from February to June 2018. All images were independently reviewed by two radiologists for the diagnosis of intracranial lesion and scored image quality using visual analysis. One technician measured signal-to-noise ratio. The agreement for diagnosis of intracranial lesion was calculated, and the intra- and interobserver agreements were analyzed by using kappa value. For the diagnosis of intracranial lesion, the conventional and wave-CAIPI MPRAGE demonstrated 99.7% of agreement (297 of 298) in the pooled analysis with very good agreement (k = 0.994). Intra- and inter-observer agreement showed very good (k > 0.9 in all) and good (k > 0.75) agreement, respectively. In the quantitative analysis, the signal-to-noise ratio had no difference (P > 0.05 for all). The overall image quality was poorer in images of wave-CAIPI MPRAGE (P < 0.001), but motion artifact had no difference between two sequences (P = 0.06). Compared to conventional MPRAGE, pre-contrast 3D T1 wave-CAIPI MPRAGE achieved higher agreement for the diagnosis of intracranial lesions and reduced the scan time by approximately 50%.

Analysis of microRNA signatures in ischemic stroke thrombus.

BACKGROUND: We investigated the microRNA expression pattern from thrombus retrieved by mechanical thrombectomy in acute stroke patients to understand the stroke mechanism. METHODS: This study included acute ischemic stroke patients who had undergone intra-arterial thrombectomy at Chung-Ang University Hospital in Seoul, Korea between February 2016 and March 2019. The thrombus was retrieved and stored at -70℃ after obtaining informed consent. MicroRNA microarray analysis was performed for the patients with identified stroke mechanisms including (1) large artery atherosclerosis, (2) cardioembolism with atrial fibrillation, and (3) cardioembolism with valvular heart disease. The microRNAs derived from microarray analysis were validated by quantitative real-time polymerase chain reaction (qRT-PCR) from different patient populations. The correlation analysis was performed between microRNA levels and laboratory data to understand the functional relevance of the altered microRNA. RESULTS: In total, 55 thrombi were obtained from 74 patients, and the microRNAs were analyzed in 45 samples. Microarray analysis of 2578 microRNAs revealed that 50 microRNAs were significantly altered among the three groups. Validation using qRT-PCR showed that miR-378f and miR-450b-5p were significantly elevated among the cardioembolic thrombi; both microRNAs were inversely correlated with the ejection fraction from echocardiography. Thrombi from patients with early neurological deterioration exhibited higher levels of miR-93-5p and lower levels of miR-629-5p than those from neurologically stable patients. CONCLUSIONS: The microRNA expression pattern can provide information regarding the mechanism of stroke by reflecting the underlying pathological status of the organ from which the thrombus was derived.

A Case Report of Pontine Infarction as an Initial Manifestation of Systemic Lupus Erythematosus: Diagnostic Clues from MRI and Digital Subtraction Angiography.

Brainstem infarction due to vertebrobasilar insufficiency is a rare initial presentation of systemic lupus erythematosus (SLE) patients and small-vessel dissection as the direct cause of infarction has not been reported. We report the case of a 20-year-old female with acute infarction on the right side of the pons due to a small artery (pontine perforator) dissection, identified on digital subtraction angiography and high-resolution vessel wall MRI (vwMRI). She was diagnosed with SLE based on the presence of neurologic disorders and relevant laboratory findings. The pontine perforator-dissecting aneurysm had occluded and the right distal vertebral artery had resolved on subsequent vwMRI. She had a modified Rankin Scale (mRS) score of 1 at discharge with mild symptom improvement, and exhibited no further aggravation of symptoms at 3 or 12 months, maintaining an mRS score of 1.

Neurointervention in the Era of COVID-19: Korean Nationwide Survey, Literature Review, and Recommendations.

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had a tremendous impact on healthcare systems worldwide. Although the most common presentation of COVID-19 is respiratory illness, neurologic manifestations are increasing and the pandemic may have consequential effects on urgent conditions such as acute ischemic stroke. In this document, we describe the current status of neurointervention in Korea affected by COVID-19 based on a nationwide survey and review relevant literature from other countries and professional societies.

Clinical outcomes of first-pass effect after mechanical thrombectomy for acute ischemic stroke: A systematic review and meta-analysis.

OBJECTIVE: The first-pass effect (FPE) during a mechanical thrombectomy for ischemic stroke results in favorable clinical outcomes and low symptomatic intracranial hemorrhage (sICH) rates according to individual observational studies. We performed an integrated study-level meta-analysis to compare the clinical outcomes and safety profiles of single (FPE group) and multiple passages (non-FPE group) of devices in patients who achieved successful recanalizations. METHODS: A literature search of the PubMed, Embase, and Cochrane databases for FPE was conducted. We included studies comparing outcomes between patients with and without FPE for 90-day favorable outcome, mortality, and sICH. The results from the pooled analysis using the random-effects model were presented as odds ratios (OR) and 95% confidence intervals (CI). RESULTS: Of the 8 selected studies comprising 2308 patients, the overall rates of the FPE were 40.3% (930/2308). The FPE was significantly associated with more 90-day favorable outcomes (OR: 1.31, 95% CI: 1.13-1.51) and lower mortality (OR: 0.53, 95% CI: 0.34-0.81), but there were no significant differences in sICH rates (OR: 0.80, 95% CI: 0.50-1.30). The results of the meta-regression analysis showed that there was no confounding effect of intravenous thrombolysis prior to thrombectomy. CONCLUSION: Our findings indicated that patients who achieved the FPE would have more 90-day favorable outcomes and lower mortality compared with non-FPE patients. However, there was a limited association between the FPE and reduced sICH rates.

The Effect of Locally Administered Fibrinolytic Drugs Following Aneurysmal Subarachnoid Hemorrhage : A Meta-Analysis with Eight Randomized Controlled Studies.

OBJECTIVE: Rapid dissolution of blood clots reduces vasospasm and hydrocephalus after subarachnoid hemorrhage (SAH), and locally administered fibrinolytic drugs (LAFDs) could facilitate the dissolution. However, the efficacy of LAFDs remains controversial. The aim of this meta-analysis was to determine the efficacy of LAFDs for vasospasm and hydrocephalus and in clinical outcomes. METHODS: From PubMed, EMBASE, and Cochrane database, data were extracted by two authors. Meta-analysis was performed using a random effect model. Inclusion criteria were patients who had LAFDs with urokinase-type or recombinant tissue-plasminogen activator after SAH in comparison with medically untreated patients with fibrinolytic drugs. We only included randomized controlled trials (RCTs) in this analysis. The outcomes of interest were vasospasm, hydrocephalus, mortality, and 90-day unfavorable functional outcome. RESULTS: Data from eight RCTs with 550 patients were included. Pooled-analysis revealed that the LAFDs were significantly associated with lower rates of vasospasm (LAFDs group vs. control group, 26.5% vs. 39.2%; odds ratio [OR], 0.48; 95% confidence interval [CI], 0.32-0.73); hydrocephalus (LAFDs group vs. control group, 26.0% vs. 31.6%; OR, 0.54; 95% CI, 0.32-0.91); and mortality (LAFDs group vs. control group, 10.5% vs. 15.7%; OR, 0.58; 95% CI, 0.34-0.99). The proportion of 90-day unfavorable outcomes was lower in the LAFDs group (LAFDs group vs. control group, 32.7% vs. 43.5%; OR, 0.55; 95% CI, 0.37-0.80). CONCLUSION: This meta-analysis with eight RCTs indicated that LAFDs were significantly associated with lower rates of vasospasm and hydrocephalus after SAH. Thus, LAFDs could consequently reduce mortality and improve clinical outcome after SAH.