Implementation of a sagittal T2-weighted DIXON turbo spin-echo sequence may shorten MRI acquisitions in the emergency setting of suspected spinal bleeding.

BACKGROUND: Magnetic resonance imaging (MRI) is the modality of choice for evaluating soft tissue damage along the spine in the emergency setting, yet access and fast protocol availability are limited. We assessed the performance of a sagittal T2-weighted DIXON turbo spin-echo sequence and investigated whether additional standard sagittal T1-weighted sequences are necessary in suspected spinal fluid collections/bleedings. METHODS: Seventy-four patients aged 62.9 ± 19.3 years (mean ± standard deviation) with MRI including a sagittal T2-weighted DIXON sequence and a T1-weighted sequence were retrospectively included. Thirty-four patients (45.9%) showed a spinal fluid collection/bleeding. Two layouts (layout 1: fat-only and water-only and in-phase images of the DIXON sequence and T1-weighted images; layout 2: fat-only and water-only and in-phase images of the DIXON sequence) were evaluated by three readers (R1, R2, and R3) concerning presence of spinal fluid collections/bleedings and diagnostic confidence from 1 (very low confidence) to 5 (very high confidence). χ2 and κ statistics were used. RESULTS: There was no difference in detecting spinal fluid collections/bleedings between the layouts (R1 and R2 detected all, R3 missed one spinal fluid collection/bleeding in the same patient in both layouts). Confidence was high (layout 1, R1 4.26 ± 0.81, R2 4.28 ± 0.81, R3 4.32 ± 0.79; layout 2, R1 3.93 ± 0.70, R2 4.09 ± 0.86, R3 3.97 ± 0.73), with higher inter-reader agreement for layout 1 (κ 0.691-0.780) than for layout 2 (κ 0.441-0.674). CONCLUSIONS: A sagittal T2-weighted DIXON sequence provides diagnostic performance similar to a protocol including standard T1-weighted sequences.

Impact of aspiration catheter size on first-pass effect in the combined use of contact aspiration and stent retriever technique.

BACKGROUND AND PURPOSE: The first-pass effect (FPE), defined as a first-pass Expanded Treatment in Cerebral Ischaemia (eTICI) 2c/3 reperfusion, has emerged as a key metric of efficacy in mechanical thrombectomy (MT) for acute ischaemic stroke. The proximal balloon occlusion together with direct thrombus aspiration during stent retriever thrombectomy (PROTECT)-PLUS technique consists in the use of a balloon guide catheter and a combined MT approach involving contact aspiration and a stent retriever. The aim of this study is to assess the effectiveness and safety of the PROTECT-PLUS technique using distal aspiration catheters (DACs) with different inner diameters by comparing the large-bore DAC Catalyst 7 versus the use of medium-bore DACs. METHODS: Retrospective analysis of a prospectively maintained database of patients treated with PROTECT-PLUS using Catalyst 7, Catalyst 6 or Catalyst 5 with an occlusion of either the terminal carotid artery or the M1 or M2 segments of the middle cerebral artery from 2018 to 2020 in two comprehensive stroke centres. Baseline characteristics and procedural, safety and clinical outcomes were compared between groups. Multivariable logistic regression analysis was performed in order to find independent predictors of FPE. RESULTS: We identified 238 consecutive patients treated with PROTECT-PLUS as front-line approach using Catalyst 7 (n=86), Catalyst 6 (n=78) and Catalyst 5 (n=76). The rate of FPE was higher with Catalyst 7 (54%) than Catalyst 6 (33%, p=0.009) and Catalyst 5 (32%, p=0.005), in addition to higher final eTICI 2c/3 reperfusion rates, shorter procedural times, lower need of rescue therapy and fewer procedure-related complications. After multivariable analysis the sole independent factor associated to FPE was the use of Catalyst 7 (OR 2.34; 95% CI 1.19 to 4.58; p=0.014). CONCLUSION: Further development of combined MT by incorporating larger-bore aspiration catheters is associated with higher reperfusion rates, shorter procedure times, and lower need of rescue therapy while reducing the complication rates.