Arjen Lindenholz

174 CHAPTER 7 Nevertheless, there were significant more enhancing foci in the IAT-group, despite the longer time window. Finally, discrimination between eccentric or concentric enhancing foci can be challenging and in clinical practice, certainly there is an overlap in enhancement configuration and the causes of vessel wall enhancement. Histopathologic validation of the detected enhancement would have given insight into the true nature / composition of the enhancing vessel wall areas (due to IAT procedure, thrombus-related or pre-existing atherosclerotic plaques); however, this necessitates ex vivo tissue which was not available. Therefore, some of the enhancing foci detected in our study participants might be explained by one of these other mechanisms of wall enhancement. Patients should ideally also have been scanned before the IAT procedure, but due to the limited time frame in which IAT can be performed, this is difficult to accomplish in clinical practice. Conclusions IAT using thrombosuction did show more (concentric) enhancing foci of the vessel wall ipsilateral to the occlusion site compared with the patients without IAT, suggesting reactive changes of the vessel wall. In an era in which MRI vessel wall studies are expected to be increasingly performed in the diagnostic work- up and follow-up of patients with acute stroke, the patterns of vessel walls enhancement after thrombectomy need to be known to avoid misinterpretation of these enhancing patterns in the follow-up MRI examinations after acute stroke treatment.