Abstract
There is a discrepancy between successful recanalization and good clinical outcome after endovascular treatment (EVT) in acute ischemic stroke patients. During removal of a thrombus, a shower of microemboli may release and lodge to the distal circulation. The objective of this study was to determine the extent of damage on brain tissue caused by microemboli. In a rat model of microembolization, a mixture of microsphere (MS) sizes (15, 25 and 50 µm diameter) was injected via the left internal carotid artery. A 3D image of the left hemisphere was reconstructed and a point-pattern spatial analysis was applied based on G- and K-functions to unravel the spatial correlation between MS and the induced hypoxia or infarction. We show a spatial correlation between MS and hypoxia or infarction spreading up to a distance of 1000–1500 µm. These results imply that microemboli, which individually may not always be harmful, can interact and result in local areas of hypoxia or even infarction when lodged in large numbers.
Highlights
Among cardiovascular diseases, stroke is the second leading cause of death and the third leading cause of disability worldwide
During endovascular treatment (EVT), the thrombus is removed by aspiration catheters or stent retrievers, more recently extended with proximal flow arrest and aspiration (Munich et al, 2019)
We found that polystyrene microspheres (MS) occlude arteriole-sized vessels in the brain, leading to tissue hypoxia and infarction after 24 h (Georgakopoulou et al, 2021)
Summary
Stroke is the second leading cause of death and the third leading cause of disability worldwide. Acute ischemic stroke (AIS; i.e. thrombotic or embolic occlusion of a cerebral artery) accounts for about 80% of stroke cases (Bamford et al, 1991). Next to thrombolysis, endovascular treatment (EVT) has been included in the standard treatment of AIS. During EVT, the thrombus is removed by aspiration catheters or stent retrievers, more recently extended with proximal flow arrest and aspiration (Munich et al, 2019). EVT results in the majority of cases (up to 95%) in suc cessful recanalization of the occluded vessel (Bhaskar et al, 2018). A large proportion of the patients (63%) has poor functional outcome (Wollenweber et al, 2019), which may be caused by subopti mal local perfusion of the brain tissue (Dankbaar et al, 2017)
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