Autopsy Findings After Intracranial Thrombectomy for Acute Ischemic Stroke

Abstract

Endovascular thrombectomy is an increasingly used treatment for arterial occlusion in acute stroke. Various devices (including most extensively the Mechanical Embolus Removal in Cerebral Ischemia [MERCI] Retriever device) have been used for this. We review the neuropathologic findings in 5 patients (age range, 59 to 87 years) who died acutely or as late as 38 days after procedures using the MERCI (4 patients) and Penumbra (1 patient) devices were carried out to remove thromboemboli from the middle cerebral artery. Partial recanalization was achieved by thrombectomy in all 5 patients. All patients showed extensive cerebral infarcts, 3 of 5 with clinical hemorrhagic transformations of the infarct or frank intraparenchymal hemorrhage after thrombectomy; in 1 case, this was judged to be at least partly on the basis of concomitant hypertensive microvascular disease. With 1 exception, basal arteries examined in detail by immunohistochemistry showed prominent, although usually nonocclusive (and generally nonulcerated), atheromata, often with significant luminal stenosis. One patient showed a subintimal dissection with resultant occlusion of the middle cerebral artery. In this highly selected group of patients, the vascular pathological abnormalities affecting basal arteries were variable, but complicated atherosclerosis was a common finding. Extensive irreversible brain necrosis before therapeutic procedures may have contributed to deaths.