Abstract
Purpose
Mechanical thrombectomy (mTE) proved to be effective treating acute vessel occlusions with an acceptable rate of procedural complications. Potential long-term side effects of the vessel wall trauma caused by mechanical irritation of the endothelium are unknown up to now.
Methods
From a retrospectively established database of 640 acute stroke treatments, we selected 261 patients with 265 embolic vessel occlusions treated successfully by mTE without permanent implantation of a stent. Analysis comprised the type of devices used and the number of passes performed. Digital subtraction angiography immediately after treatment was evaluated for vasospasm, dissection, and extravasation. Control angiographic images were evaluated for any morphological change compared to the immediate posttreatment angiographic run.
Results
Recanalization was achieved with a median of one (range 1–10) mTE maneuvers. Vasospasm occurred in 69 territories (26.0 %) and was treated with glyceroltrinitrate in three. Dissection was observed in one vessel (0.4 %). Intraprocedural hemorrhage in two patients (0.8 %) was either wire or device induced. Follow-up digital subtraction angiography was available for 117 territories after a median of 107 days, revealing target vessel occlusion in one segment (0.9 %) and a de novo stenosis of four segments (3.4 %). All findings were clinically asymptomatic. Posttreatment vasospasm was more frequent in patients with de novo stenosis and occlusion (p = 0.038).
Conclusion
De novo stenoses and occlusions occur in a small proportion of patients after mTE. Because all lesions were clinically asymptomatic, this finding does not affect the overall benefit of the treatment. Vasospasm may predict late vessel wall changes.
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References
National Institute of Neurological Disorders and Stroke RT-PA Stroke Study Group (1995) Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333:1581–1587
Hakke W, Kaste M, Bluhmki E et al (2008) Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 359:1317–1329
Lansberg MG, Schrooten M, Bluhmki E et al (2009) Treatment time specific number needed to treat estimates for tissue plasminogen activator therapy in acute stroke based on shifts over the entire range of the modified Rankin scale. Stroke 40:2079–2084
Saver JL, Gornbein J, Grotta J et al (2009) Number needed to treat to benefit and harm for intravenous tissue plasminogen activator therapy in the 3- to 4.5-hour window: joint outcome table analysis of the ECASS 3 trial. Stroke 40:2433–2437
Riedel CH, Zimmermann P, Jensen-Kondering U et al (2011) The importance of size: successful recanalization by intravenous thrombolysis in acute anterior stroke depends on thrombus length. Stroke 42:1775–1777
Saqqur M, Uchino K, Demchuk AM et al (2007) Site of arterial occlusion identified by transcranial Doppler predicts the response to intravenous thrombolysis for stroke. Stroke 38:948–954
Mattle HP, Arnold M, Georgiadis D et al (2008) Comparison of intraarterial and intravenous thrombolysis for ischemic stroke with hyperdense middle cerebal artery sign. Stroke 39:379–383
Smith WS, Sung G, Saver J et al (2008) Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial. Stroke 39:1205–1212
Mourand I, Brunel H, Costalat V et al (2011) Mechanical thrombectomy in acute ischemic stroke: catch device. AJNR Am J Neuroradiol 32:1381–1385
Henkes H, Reinartz J, Lowens S et al (2006) A device for fast mechanical clot retrieval from intracranial arteries (Phenox clot retriever). Neurocrit Care 5:134–140
Penumbra Pivotal Stroke Trial Investigators (2009) The penumbra pivotal stroke trial: safety and effectiveness of mechanical devices for clot removal in intracranial large vessel occlusive disease. Stroke 40:2761–2768
Pérez MA, Miloslavski E, Fischer S et al (2012) Intracranial thrombectomy using the Solitaire stent: a historical vignette. J Neurointerv Surg 4:154
Castaño C, Dorado L, Guerrero C et al (2010) Mechanical thrombectomy with the Solitaire AB device in large artery occlusion of the anterior circulation: a pilot study. Stroke 41:1836–1840
Machi P, Costalat V, Lobotesis K et al (2012) Solitaire FR thrombectomy system: immediate results in 56 consecutive acute ischemic stroke patients. J Neurointerv Surg 4:62–66
Rohde S, Haehnel S, Herweh C et al (2011) Mechanical thrombectomy in acute embolic stroke: preliminary results with the revive device. Stroke 42:2954–2956
Nedeltchev K, Schwengler B, Haefeli T et al (2007) Outcome of stroke with mild or rapidly improving symptoms. Stroke 38:2531–2535
Rajajee V, Kidwell C, Starkman S et al (2006) Early MRI and outcomes of untreated patients with mild or improving ischemic stroke. Neurology 67:980–984
Möhlenbruch M, Seifert M, Okulla T et al (2011) Mechanical thrombectomy compared to local-intraarterial thrombolysis in carotid T and middle cerebral artery occlusions: a single center experience. Clin Neuroradiol. doi:10.1007/s00062-011-0099-9
Jahan R (2010) Solitaire flow-restoration device for treatment of acute ischemic stroke: safety and recanalization efficacy study in a swine vessel occlusion model. AJNR Am J Neuroradiol 31:1938–1943
Mordasini P, Frabetti N, Gralla J et al (2011) In vivo evaluation of the first dedicated combined flow-restoration and mechanical thrombectomy device in a swine model of acute vessel occlusion. AJNR Am J Neuroradiol 32:294–300
Nogueira RG, Levy EI, Gounis M et al (2012) The Trevo device: preclinical data of a novel stroke thrombectomy device in two different animal models of arterial thrombo-occlusive disease. J Neurointerv Surg 4:295–300
Gupta R (2009) Arterial vasospasm during mechanical thrombectomy for acute stroke. J Neuroimaging 19:61–64
Smith WS, Sung G, Starkman S et al (2005) Safety and efficacy of mechanical embolectomy in acute ischemic stroke. Results of the MERCI trial. Stroke 36:1432–1440
Yin NS, Benavides S, Starkman S et al (2010) Autopsy findings after intracranial thrombectomy for acute ischemic stroke—a clinicopathologic study of 5 patients. Stroke 41:938–947
Conflict of interest
W. Kurre is a consultant to Phenox, received travel expenses from Phenox, and received speaker honoraria from Codman and Shurtleff Inc. M. Aguilar-Pérez is a consultant to Phenox. D. Horvath does not have any conflict of interest. E. Schmid received speaker honoraria from Bayer vital. H. Bäzner received speaker honoraria from Bayer vital, UCB Pharma, Biogen Idec and Boehringer Ingelheim. H. Henkes received speaker honoraria as well as travel expenses from Covidien/ev3 and Codman and Shurtleff Inc. He was cofounder of Dendron (the company that developed the Solitaire and was later acquired by ev3) and Phenox (the company that developed the pREset retriever).
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Kurre, W., Pérez, M.A., Horvath, D. et al. Does Mechanical Thrombectomy in Acute Embolic Stroke Have Long-term Side Effects on Intracranial Vessels? An Angiographic Follow-up Study. Cardiovasc Intervent Radiol 36, 629–636 (2013). https://doi.org/10.1007/s00270-012-0496-8
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DOI: https://doi.org/10.1007/s00270-012-0496-8