Abstract
Background: It has been hypothesized that intravenous recombinant tissue plasminogen activator (rt-PA) prior to mechanical thrombectomy reduces the risk of intraprocedural distal embolization in acute ischemic stroke patients. Methods: We analyzed the diffusion-weighted imaging (DWI) acquired with 1.5- or 3- Tesla magnetic resonance imaging (MRI) scans obtained within 24 hours of mechanical thrombectomy in consecutive acute ischemic stroke patients. DWI was performed with single-shot echo-planar technique at b values of 0-1000 s/mm 2 . An independent physician identified distal embolization related foci of restricted diffusion on ipsilateral and contralateral hemispheres. Distal embolization was defined as discrete foci of restricted diffusion independent of the primary area of infarction on MRI. Patients were stratified based on whether they had or did not receive intravenous rt-PA prior to thrombectomy. Results: Distal embolization was seen in 48 of 50 patients (mean age ± SD; 62.9 ± 15.5 years) who underwent mechanical thrombectomy (mean number 9.1; range 0-22). The mean number of distal embolization was not significantly different between patients who had and those who did not receive intravenous rt-PA prior to mechanical thrombectomy (9.5 ± 6.2 versus 8.7 ± 6.5; p=0.67 by ANOVA). There was no difference in mean number of ipsilateral hemispheric distal embolization between the two groups (8.5 ± 6.4 versus 7.6 ± 6.4, p=0.61 by ANOVA). There was no relationship between mean number of emboli and age of the patient (regression coefficient 0.004; p=0.94) or time interval between symptom onset and thrombectomy (regression coefficient -0.02; p=0.67) on linear regression analyses. Conclusion: Although distal embolization is very common after thrombectomy, we did not find any evidence that intravenous rt-PA prior to procedure reduces the risk of intraprocedural distal embolization.
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