Objective: The course of the vessel affects the success of recanalization and can cause complications in mechanical thrombectomy (MT); however, no study has been reported a method for outlining vessel course prior to MT. We propose magnetic resonance (MR) fusion images as a useful tool in MT for acute ischemic stroke.

Case Presentations: A 73-year-old woman and a 79-year-old man were admitted to our hospital with left hemiparesis. In both patients, MR revealed acute ischemic stroke due to right middle cerebral artery (MCA) occlusion. MR fusion images were created with 3D T2-weighted sampling perfection with application-optimized contrasts using different flip angle evolution (SPACE) and 3D time-of-flight (TOF) MRA acquired before MT clearly revealed the occluded right MCA. In both cases, the fusion image is enabled information about the course of the right MCA and its branches to be obtained prior to performing MT. The thrombi were removed with a stent retriever and reperfusion catheter with no complications, and there was remarkable resolution of symptoms in both patients immediately after the procedure.

Conclusion: A fusion image of T2-weighted SPACE and 3D TOF MRA appears to be a simple and effective method for determining the course of the occluded vessel prior to MT for acute ischemic stroke. This technique will enable good recanalization in MT for acute ischemic stroke and should reduce complications.