Neuro-endovascular Stroke Therapy and Vessel Wall Imaging Program

Stroke Therapy Program

Patients presenting with acute ischemic stroke secondary to an intracranial large vessel occlusion can benefit from endovascular thrombectomy within 24h of symptom onset.  In patients presenting within 4.5hrs, the non-inferiority of direct to mechanical thrombectomy versus thrombolysis with mechanical thrombectomy is unknown and SGH is one of the participating centres for the DIRECT-SAFE multicentre prospective randomized trial.

There is a direct correlation between better clinical outcomes with faster time from stroke onset to recanalisation.  We are actively involved in research and quality improvement processes to develop new systems of care to reduce the time taken for our patients to undergo appropriate imaging evaluation and treatment (thrombolysis and mechanical thrombectomy).

Vessel Wall Imaging for Neurovascular Diseases Program

The Singapore General Hospital Neurointerventional Radiology (NIR) team led by A/Prof Winston Lim, specializes in the diagnosis and treatment of vascular diseases affecting the brain and neck. The NIR team works closely with other clinical specialties such as Neurology, Neurosurgery and ENT; to deliver the best in multidisciplinary patient care.

Part of the NIR team's research interest is the use of high-resolution magnetic resonance imaging (MRI) to study various intracranial vascular diseases. The team is now able to use high-resolution MRI, or commonly known as Vessel Wall Imaging (VWI), to visualize the wall of small intracranial arteries rather than rely on conventional imaging techniques which only assess calibre of the vessel lumen. This translates into increased accuracy of diagnosing different intracranial vascular diseases and allows clinicians to tailor their treatment for patients.

Contact

For further information, please contact A/Prof Winston Lim, Dr Chia Ghim Song and Dr David Wen

• A/Prof Winston Lim Eng Hoe - winston.lim.e.h@singhealth.com.sg

• Dr Chia Ghim Song - chia.ghim.song@singhealth.com.sg

• Dr David Wen - david.wen.w@singhealth.com.sg

Publications:

1. Rumpel H, Khoo JB, Chang HM, Lim WE, Chen C, Wong MC, Tan KP. Correlation of the apparent diffusion coefficient and the creatine level in early ischemic stroke: a comparison of different patterns by magnetic resonance. J Magn Reson Imaging. 2001 Mar;13(3):335-43. doi: 10.1002/jmri.1048.
2. Chan LL, Kumar AJ, Leeds NE, Forman AD. Post-epidural analgesia spinal cord infarction: MRI correlation.  Acta Neurol Scand 2002;105:344-348.
3. Chan LL, Khoo JB, Thng CH, Lim WEH, Tay KH, Tan EK, Chang HM, Chen C, Wong MC, Tan KP.  Diffusion Weighted MR Imaging in Acute Stroke: the SGH Experience. Singapore Med J 2002;43:118-123.
4. Rumpel H, Lim WE, Chang HM, Chan LL, Ho GL, Wong MC, Tan KP. Is myo-inositol a measure of glial swelling after stroke? A magnetic resonance study. J Magn Reson Imaging 2003;17(1):11-9.
5. Rumpel H, Chan LL. Serial FLAIR imaging after Gd-DTPA contrast: pitfalls in stroke trial magnetic resonance imaging. Stroke 2003 Mar;34(3):797-8.
6. Low AS, Lim WE, Chan LL, Tan HM, Tan KP. Audit of diagnostic and interventional craniocervical catheter angiographic procedures at the Singapore General Hospital. Ann Acad Med Singapore 2004 Sep;33(5):607-13.
7. Gogna A, Lath N, Chang HM, Tan BS, Wong MC, Koh TH, Lim ST, Htoo MM, Lim WE. Stent-assisted percutaneous angioplasty for extra-cranial carotid disease: experience at Singapore General Hospital. Ann Acad Med Singap. 2009 Sep;38(9):756-62.
8. Lee W, Sitoh YY, Lim CC, Lim WE, Hui FK. The MERCI Retrieval System for the management of acute ischaemic stroke--the NNI Singapore experience. Ann Acad Med Singap. 2009 Sep;38(9):749-55.
9. Chan LL. Intracranial and Extracranial Atherosclerosis: More Similar Than Different? AJNR Am J Neuroradiol. 2019 Dec;40(12):2023-2024. doi: 10.3174/ajnr.A6349.