Premium
Hemodynamic Changes May Indicate Vessel Wall Injury After Stent Retrieval Thrombectomy for Acute Stroke
Author(s) -
Perren Fabienne,
Kargiotis Odysseas,
Pignat JeanMichel,
Pereira Vitor Mendes
Publication year - 2018
Publication title -
journal of neuroimaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.822
H-Index - 64
eISSN - 1552-6569
pISSN - 1051-2284
DOI - 10.1111/jon.12513
Subject(s) - medicine , vasospasm , basilar artery , stenosis , thrombolysis , cardiology , hemodynamics , middle cerebral artery , stroke (engine) , radiology , stent , occlusion , digital subtraction angiography , subarachnoid hemorrhage , angiography , ischemia , myocardial infarction , mechanical engineering , engineering
BACKGROUND AND PURPOSE Stent retrievers have revolutionized endovascular treatment of acute ischemic stroke (AIS). Animal studies showed that mechanical thrombectomy (MT) may cause endothelial injury and intimal layer edema. Using transcranial color‐coded duplex‐sonography (TCCS) we observed postprocedural hemodynamic changes in the treated vessel. METHODS We studied AIS patients with large intracranial artery occlusion in whom MT with stent retrievers was performed. Only those with complete recanalization (modified TICI‐2b or 3) as assessed by postprocedural digital subtraction angiography (DSA) and in whom early control TCCS was performed were retained. Patients treated with intra‐arterial thrombolysis or stenting were excluded. RESULTS In 31 patients treated within a time period of 4 years (29 with middle cerebral artery [MCA] and 2 with basilar artery [BA] occlusion), postacute stroke brain‐DSA confirmed complete recanalization without residual stenosis or vasospasm. However, in 27 (17 men, mean age 66.3 years) of them TCCS (mean 3.4 days after MT) showed very segmental acceleration of blood flow velocities in the affected arteries (MCA maximum peak systolic velocity [PSVmax] at least >35% as compared to the contralateral side at the same depth; BA PSVmax >40% as compared to velocities at different depths of the same vessel). None showed clinical deterioration. TCCS follow‐up (mean 20 days) showed normalization in 14 of 16 cases. CONCLUSION Our TCCS study provides preliminary evidence of focal acceleration of blood flow velocities after MT. Without residual stenosis or vasospasm, this may be a sign of endothelial layer disruption/intimal injury. Further studies are needed to confirm our results.