Introduction Intracranial atherosclerotic disease (ICAD) is sometimes discovered during mechanical thrombectomy for acute ischemic stroke. In the event of partial or failed recanalization, termination of the procedure is typically determined by interpretation of the angiogram. Although some retrospective studies have suggested that rescue intracranial stenting is safe and effective in this setting, others have suggested that intracranial stenting may increase risk of intracranial hemorrhage. In difficult cases that result in partial or failed recanalization, MRI would be helpful to definitively discriminate viable from infarcted cerebral tissue and determine operative course.

Methods We performed a retrospective single institution review of all acute stroke patients who underwent thrombectomy and intraprocedural MRI. From October 2019 to March 2020, eight patients underwent intraprocedural 3 Tesla MRI during mechanical thrombectomy for acute ischemic stroke intervention in a hybrid angiography-MRI suite. Diffusion-weighted (DWI; b-value=1000 s/mm²) and T2-weighted sequences were obtained. The electronic medical record was reviewed to determine clinical outcomes.

Results In all cases, the intraprocedural MRI was obtained to determine the extent of core infarct, and played a pivotal role in decision-making. In particular, operators used the MRI to make decisions regarding intracranial stent placement, administration of antiplatelet medications or heparin, and blood pressure parameters. p { margin-bottom: 0.1in; line-height: 115%; background: transparent } In four patients who underwent partial recanalization (TICI 2a or less), intracranial stents were placed in 2 based on MRI results. In the remaining patients, MRI informed the time course for postoperative initiation of anticoagulant medications and blood pressure parameters.

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Abstract E-164 Figure 1

Conclusion Hybrid angiography-MRI units offer a unique capability to inform neurointerventionalists of the viability of the tissue they are attempting to salvage during complex cerebrovascular interventions. Integrating MRI into the stroke treatment angiography suite may thereby improve individual patient selection and treatment selection.

Disclosures K. Narsinh: None. B. Kilbride: None. K. Mueller: 5; C; Siemens Healthineers. J. Vitt: None. J. Massachi: None. M. Amans: 1; C; NIH. D. Cooke: 1; C; Siemens Healthineers. M. Wilson: None. S. Hetts: 1; C; Siemens Healthineers, NIH. 2; C; Imperative Medical, MicroVention Terumo, Route 92 Medical.