Protected stent retriever thrombectomy prevents iatrogenic emboli in new vascular territories

Klinger-Gratz, Pascal P; Schroth, Gerhard; Gralla, Jan; Jung, Simon; Weisstanner, Christian; Verma, Rajeev Kumar; Mordasini, Pasquale; Kellner-Weldon, Frauke; Hsieh, Kety Wha-Vei; Heldner, Mirjam Rachel; Fischer, Urs; Arnold, Marcel; Mattle, HP; El-Koussy, Marwan (2015). Protected stent retriever thrombectomy prevents iatrogenic emboli in new vascular territories. Neuroradiology, 57(10), pp. 1045-1054. Springer 10.1007/s00234-015-1583-8

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INTRODUCTION Diagnostic 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. METHODS Patients 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. RESULTS In 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. CONCLUSION Our 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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Schroth, Gerhard; Gralla, Jan; Jung, Simon; Weisstanner, Christian; Verma, Rajeev Kumar; Mordasini, Pasquale; Kellner-Weldon, Frauke; Hsieh, Kety Wha-Vei; Heldner, Mirjam Rachel; Fischer, Urs; Arnold, Marcel; Mattle, Heinrich and El-Koussy, Marwan

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0028-3940

Publisher:

Springer

Language:

English

Submitter:

Valentina Rossetti

Date Deposited:

30 Sep 2015 16:16

Last Modified:

29 Dec 2017 09:43

Publisher DOI:

10.1007/s00234-015-1583-8

PubMed ID:

26319999

BORIS DOI:

10.7892/boris.72084

URI:

https://boris.unibe.ch/id/eprint/72084

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