Abstract
Background and objective: Procedural thromboembolisms after mechanical thrombectomy (MT) for acute ischemic stroke has rarely been studied. We retrospectively evaluated factors associated with procedural thromboembolisms after MT using diffusion-weight imaging (DWI) within 2 days of MT. Materials and Methods: From January 2018 to March 2020, 78 patients with acute ischemic stroke who underwent MT were evaluated using DWI. Procedural thromboembolisms were defined as new cerebral infarctions in other territories from the occluded artery on DWI after MT. Results: Procedural thromboembolisms were observed on DWI in 16 patients (20.5%). Procedural thromboembolisms were associated with old age (73.8 ± 8.18 vs. 66.8 ± 11.2 years, p = 0.021), intravenous (IV) thrombolysis (12 out of 16 (75.0%) vs. 25 out of 62 (40.3%), p = 0.023), heparinization (4 out of 16 (25.0%) vs. 37 out of 62 (59.7%), p = 0.023), and longer procedural time (90.9 ± 35.6 vs. 64.4 ± 33.0 min, p = 0.006). Multivariable logistic regression analysis revealed that procedural thromboembolisms were independently associated with procedural time (adjusted odds ratio (OR); 1.020, 95% confidence interval (CI); 1.002–1.039, p = 0.030) and IV thrombolysis (adjusted OR; 4.697, 95% CI; 1.223–18.042, p = 0.024). The cutoff value of procedural time for predicting procedural thromboembolisms was ≥71 min (area under the curve; 0.711, 95% CI; 0.570–0.851, p = 0.010). Conclusions: Procedural thromboembolisms after MT for acute ischemic stroke are significantly associated with longer procedural time and IV thrombolysis. This study suggests that patients with IV thrombolysis and longer procedural time (≥71 min) are at a higher risk of procedural thromboembolisms after MT for acute ischemic stroke.
Highlights
Mechanical thrombectomy (MT) of a major vessel occlusion of the anterior circulation has become a standard treatment for acute ischemic stroke
As recanalization is thebeen major goal of mechanical thrombectomy (MT) study, for acute ischemic stroke, procedural for acute ischemic stroke has rarely studied. In this we aimed to evaluate factors affecting thromboembolisms have not been considered as important as recanalization, and procedural procedural thromboembolisms after MT for acute ischemic stroke using diffusion-weight imaging (DWI)
The multivariable logistic regression analysis for factors affecting procedural thromboembolisms after MT for acute ischemic stroke, including age, IV thrombolysis, heparinization, and procedural time, showed that procedural time (adjusted odds ratio (OR); 1.020, 95% confidence interval (CI); 1.002–1.039, p = 0.030) and IV thrombolysis were independently associated with procedural thromboembolisms after MT for acute ischemic stroke (Table 3)
Summary
Mechanical thrombectomy (MT) of a major vessel occlusion of the anterior circulation has become a standard treatment for acute ischemic stroke. Several studies have evaluated the risk factors of procedural thromboembolisms using diffusion-weighted imaging (DWI) after endovascular procedures. Procedural thromboembolisms after endovascular procedures are associated with the type and dose of antiplatelet drug, resistance to the antiplatelet drug, the procedural time, the number of DWI-positive lesions, and the type of device used [6,7,8,9]. These previous studies on procedural thromboembolisms have focused on coil embolization for cerebral aneurysms and carotid artery stenting for carotid artery stenosis.
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