Abstract
Background and aimTo analyze the incidence of peripheral emboli after successful mechanical thrombectomy (MT) of intracranial large vessel occlusions (LVO).MethodsWe performed a prospective analysis of patients with intracranial LVO who underwent successful MT and received a 1.5 T MRI including diffusion-weighted imaging (DWI) in standard- and high-resolution as well as susceptibility-weighted imaging (SWI) on the day following the intervention. Reperfusion grade was assessed on post-thrombectomy digital subtraction angiography (DSA) using the expanded thrombolysis in cerebral infarction (eTICI) scale. Punctuate DWI lesions distal to the DWI core lesion were classified as peripheral emboli. DWI lesions outside the primary affected vascular territory were classified as emboli into new territories. Additionally, SWI and post-thrombectomy DSA were analyzed and correlated to findings on DWI.ResultsTwenty-eight patients undergoing successful MT met the inclusion criteria. In 26/28 patients (93%), a total of 324 embolic lesions were detected in DWI representing 2.1% of the cumulated ischemic core volume. 151 peripheral emboli were detected in standard-resolution DWI, 173 additional emboli were uncovered in high-resolution DWI. Eight out of nine patients with an eTICI 3 reperfusion had embolic lesions (29 DWI lesions). 9.6% (31/324) of peripheral emboli were observed in vascular territories not affected by the LVO. SWI lesions were observed in close proximity to 10.2% (33/324) of DWI lesions.ConclusionsPeripheral emboli are frequent after MT even after complete reperfusion. These emboli occur rather in the vascular territory of the occluded vessel than in other territories. A large proportion of peripheral emboli is only detected by high-resolution DWI.
Highlights
Multiple randomized trials have demonstrated the benefit of mechanical thrombectomy (MT) for acute ischemic stroke due to large vessel occlusion (LVO) [1, 2]
Clinical outcome after MT can be improved by an increasing degree of reperfusion evaluated by the expanded thrombolysis in cerebral infarction scale [3, 4]
With a total of 324 lesions high resolution diffusion-weighted imaging (DWI) detected significantly more peripheral emboli compared to standard resolution DWI
Summary
Multiple randomized trials have demonstrated the benefit of mechanical thrombectomy (MT) for acute ischemic stroke due to large vessel occlusion (LVO) [1, 2]. Clinical outcome after MT can be improved by an increasing degree of reperfusion evaluated by the expanded thrombolysis in cerebral infarction (eTICI) scale [3, 4]. To analyze the incidence of peripheral emboli after successful mechanical thrombectomy (MT) of intracranial large vessel occlusions (LVO). Methods We performed a prospective analysis of patients with intracranial LVO who underwent successful MT and received a 1.5 T MRI including diffusion-weighted imaging (DWI) in standard- and high-resolution as well as susceptibility-weighted imaging (SWI) on the day following the intervention. Reperfusion grade was assessed on post-thrombectomy digital subtraction angiography (DSA) using the expanded thrombolysis in cerebral infarction (eTICI) scale. Eight out of nine patients with an eTICI 3 reperfusion had embolic lesions (29 DWI lesions). Conclusions Peripheral emboli are frequent after MT even after complete reperfusion These emboli occur rather in the vascular territory of the occluded vessel than in other territories. A large proportion of peripheral emboli is only detected by high-resolution DWI
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