Neuro-endovascular Stroke Therapy and Vessel Wall Imaging Programme

Stroke Therapy Programme

Patients presenting with acute ischemic stroke secondary to an intracranial large vessel occlusion can benefit from endovascular thrombectomy within 24 hours of symptom onset. In patients presenting within 4.5 hours, 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 randomised 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 Programme

The Singapore General Hospital Neurointerventional Radiology (NIR) team led by A/Prof Winston Lim, specialises 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 visualise 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. Zhang Z, Lim JX, Wen D, Wong CP, Lim WEH, Chia GS. Adjunct Middle Meningeal Artery Embolization Versus Surgery for Chronic Subdural Hematoma: A Systematic Review and Meta-Analysis. Neurosurg Rev. 2024 Nov 28;47(1):876. doi: 10.1007/s10143-024-03107-3. PMID: 39607623. 
2. Liu Z, Leong MQ, Li N, Teo MM, Leong WR, Wong SCP, Chew JS, Saffari SE, Pang YH, Chia GS. Reducing Door-to-Puncture Times for Mechanical Thrombectomy in a Large Tertiary Hospital. Neurol Clin Pract. 2024 Oct;14(5):e200325. doi: 10.1212/CPJ.0000000000200325. Epub 2024 Jun 4. PMID: 38939047; PMCID: PMC11201277. 
3. Liu Z, Wong SCP, Leong M, Li N, Teo MM, Leong R, Chew JS, Pang YH, Chia GS. P130 Shortening door-to-puncture time (DPT) for mechanical thrombectomy (MT) in ischemic stroke in Singapore’s largest hospital. Journal of NeuroInterventional Surgery. 2024 Sep 3;16:A103. 
4. Lim JX, Lim YG, Kumar A, Cheong TM, Han JX, Chen MW, Wen D, Lim W, Ng IHB, Ng VYP, Kirollos RW, Keong NCH. Relevance of presenting risks of frailty, sarcopaenia and osteopaenia to outcomes from aneurysmal subarachnoid haemorrhage. BMC Geriatr. 2022 Apr 16;22(1):333. doi: 10.1186/s12877-022-03005-7. PMID: 35428266; PMCID: PMC9013113. 
5. 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. 
6. Lim JX, Han JX, See AAQ, Lew VH, Chock WT, Ban VF, Pothiawala S, Lim WEH, McAdory LE, James ML, King NKK. External Validation of Hematoma Expansion Scores in Spontaneous Intracerebral Hemorrhage in an Asian Patient Cohort. Neurocrit Care. 2019 Apr;30(2):394-404. doi: 10.1007/s12028-018-0631-8. PMID: 30377910.