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Neuroradiology

, Volume 57, Issue 10, pp 1045–1054

First Online: 29 August 2015Received: 19 May 2015Accepted: 19 August 2015

Abstract

IntroductionDiagnostic tools to show emboli reliably and protection techniques against embolization when employing stent retrievers are necessary to improve endovascular stroke therapy.
The aim of the present study was to investigate iatrogenic emboli using susceptibility-weighted imaging SWI in an open series of patients who had been treated with stent retriever thrombectomy using emboli protection techniques.

MethodsPatients with anterior circulation stroke examined with MRI before and after stent retriever thrombectomy were assessed for iatrogenic embolic events.
Thrombectomy was performed in flow arrest and under aspiration using a balloon-mounted guiding catheter, a distal access catheter, or both.

ResultsIn 13 of 57 patients 22.8 % post-interventional SWI sequences detected 16 microemboli.
Three of them were associated with small ischemic lesions on diffusion-weighted imaging DWI.
None of the microemboli were located in a new vascular territory, none showed clinical signs, and all 13 patients have been rated as Thrombolysis in Cerebral Infarction TICI 2b n = 3 or 3 n = 10.
Retrospective reevaluation of the digital subtraction angiography DSA detected discrete flow stagnation nearby the iatrogenic microemboli in four patients with a positive persistent collateral sign in one.

ConclusionOur study demonstrates two things: First, SWI seems to be more sensitive to detect emboli than DWI and DSA and, second, proximal or distal protected stent retriever thrombectomy seems to prevent iatrogenic embolization into new vascular territories during retraction of the thrombus, but not downstream during mobilization of the thrombus.
Both techniques should be investigated and refined further.

KeywordsStroke Stent retriever SWI Collaterals TICI The paper was previously presented in part at the 37 Annual Meeting of the European Society of Neuroradiology, September 28 to October 1, 2013, Frankfurt, Germany.

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Autor: Pascal P. Klinger-Gratz - Gerhard Schroth - Jan Gralla - Simon Jung - Christian Weisstanner - Rajeev K. Verma - Pasquale 

Fuente: https://link.springer.com/



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