Negative Susceptibility Vessel Sign and Underlying Intracranial Atherosclerotic Stenosis in Acute Middle Cerebral Artery Occlusion

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Fig 1.
Brain images from a 74-year-old man with acute ischemic stroke and atherosclerotic stenosis in the MCA. A, 3D TOF MR angiography shows the occlusion in the proximal M1 segment of the left MCA. B, Axial gradient-echo image reveals a negative susceptibility vessel sign (arrows) in the M1 segment of the left MCA. C, Angiography after 1 passage of the Solitaire stent identifies a severe stenosis (arrow) in the proximal M1 segment of the left MCA. No thrombi were retrieved with the Solitaire stent. D, Angiography after intracranial angioplasty with stent placement shows complete revascularization in the left MCA territory.
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Fig 2.
Brain images from a 74-year-old man with acute ischemic stroke and atrial fibrillation. A, 3D TOF MR angiography shows the occlusion in the M1 segment of the left MCA. B, Axial gradient-echo image reveals a positive susceptibility vessel sign (arrows) in the distal M1 segment of the left MCA. C, Conventional angiography shows the occlusion in the M1 segment of the left MCA. D, Angiography after 1 passage of the Solitaire stent shows complete revascularization in the left MCA territory. E, Photograph demonstrates red clots retrieved with a Solitaire stent.

Table 1:

Comparison between the negative SVS group and positive SVS group

	Negative SVS Group (n = 42)	Positive SVS Group (n = 49)	P Value
Age (yr)	69.1 ± 11.60	68.4 ± 11.40	NS
Male sex	21 (50%)	31 (63.3%)	NS
Risk factors
Hypertension	26 (61.9%)	27 (55.1%)	NS
Diabetes mellitus	10 (23.8%)	4 (8.2%)	.046
Coronary artery disease	3 (7.1%)	2 (4.1%)	NS
Dyslipidemia	19 (45.2%)	10 (20.4%)	.011
Smoking	8 (19.0%)	17 (34.7%)	NS
Atrial fibrillation	12 (28.6%)	27 (55.1%)	.011
Congestive heart failure	1 (2.4%)	1 (2.0%)	NS
History of stroke or TIA	7 (16.7%)	5 (10.2%)	NS
Occlusion sites
M1 segment	38 (90.5%)	46 (93.9%)	NS
M2 segment	4 (9.5%)	3 (6.1%)	NS
IV thrombolysis	20 (47.6%)	34 (69.4%)	NS
Time to procedure (min)	240 ± 115.9	250 ± 74.3	NS
Procedure time (min)	31.5 ± 9.3	30 ± 18.0	NS
Time to revascularization (min)	280 ± 117.8	276 ± 78.3	NS
Baseline NIHSS score	9.5 ± 3.7	13 ± 3.7	.003
Stroke subtypes
Cardioembolic	11 (26.2%)	29 (59.2%)	.002
Large artery atherosclerosis	24 (57.1%)	9 (18.4%)	<.001
Others	0%	0%	NS
Undetermined	7 (16.7%)	11 (22.4%)	NS
m-TICI 2b or 3	38 (90.5%)	39 (79.6%)	NS
mRS 0–2	28 (66.7%)	21 (42.9%)	.023
Mortality	5 (11.9%)	4 (8.2%)	NS

Table 2:

Comparison between the ICAS group and non-ICAS group

	ICAS Group (n = 18)	Non-ICAS Group (n = 73)	P Value
Age (yr)	63.8 ± 10.4	69.9 ± 11.4	.026
Male sex	11 (61.1%)	41 (56.2%)	NS
Risk factors
Hypertension	12 (66.7%)	41 (56.2%)	NS
Diabetes mellitus	7 (38.9%)	7 (9.6%)	.002
Coronary artery disease	0 (0%)	5 (6.8%)	NS
Dyslipidemia	12 (66.7%)	17 (23.2%)	<.001
Smoking	3 (16.7%)	22 (30.1%)	NS
Atrial fibrillation	1 (5.6%)	38 (52.1%)	<.001
Congestive heart failure	0 (0%)	2 (2.7%)	NS
History of stroke or TIA	1 (5.6%)	11 (15.1%)	NS
Occlusion sites
M1 segment	18 (100%)	66 (90.4%)	NS
M2 segment	0 (0%)	7 (9.6%)	NS
IV thrombolysis	7 (38.9%)	47 (64.4%)	NS
Time to procedure (min)	253.8 ± 115.9	250.5 ± 74.2	NS
Procedure time (min)	31.9 ± 9.3	33.6 ± 18.0	NS
Time to revascularization (min)	285.8 ± 117.8	284.3 ± 78.2	NS
Baseline NIHSS score	9.8 ± 3.6	12.7 ± 3.7	.003
m-TICI 2b or 3	18 (100%)	59 (80.8%)	.043
mRS 0–2	14 (77.8%)	35 (47.9%)	.034
Mortality	1 (5.6%)	8 (10.9%)	NS
N-SVS	18 (100%)	24 (32.9%)	<.001

Note:—N-SVS indicates negative susceptibility vessel sign; m-TICI, modified TICI; NS, non-significant.