Efficacy of the MRA-Based Road Mapping of the Para-Aortic Access Route before Mechanical Thrombectomy in Patients with Acute Ischemic Stroke

Abstract

<b><i>Introduction:</i></b> The aim of this study was to clarify whether magnetic resonance angiography (MRA)-based road mapping of the para-aortic transfemoral access route can reduce the procedural time of mechanical thrombectomy in patients with acute ischemic stroke. We further investigated the role of pre-procedural MRA-based road mapping in optimal initial catheter selection for rapid mechanical thrombectomy. <b><i>Materials and Methods:</i></b> We retrospectively reviewed 57 consecutive patients with acute ischemic stroke who underwent mechanical thrombectomy at our hospital between April 2018 and May 2021. Twenty-nine patients underwent MRA-based road mapping to visualize the para-aortic access route, whereas 28 patients only underwent routine head magnetic resonance imaging/angiography without MRA-based road mapping before neuro-interventional procedures. We then compared the basic procedural times required for mechanical thrombectomy, such as the time from femoral artery puncture to recanalization (“puncture to recanalization time”) and the time from the admission to recanalization (“door to recanalization time”), between the groups. <b><i>Results:</i></b> MRA-based road mapping significantly reduced the “puncture to recanalization time” (52.0 min vs. 70.0 min; <i>p</i> = 0.019) and the “door to recanalization time” (146 min vs. 183 min; <i>p</i> = 0.013). <b><i>Conclusion:</i></b> MRA-based road mapping of the para-aortic access route is useful to reduce the procedural time of mechanical thrombectomy in acute stroke patients, possibly by enabling optimal initial catheter selection during the procedure.