Cargando…

Sub-angiographic peripheral emboli in high resolution DWI after endovascular recanalization

BACKGROUND AND AIM: 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...

Descripción completa

Detalles Bibliográficos
Autores principales: Schönfeld, Michael H., Kabiri, Reza, Kniep, Helge C., Meyer, Lukas, Sedlacik, Jan, Ernst, Marielle, Broocks, Gabriel, Faizy, Tobias D., Cheng, Bastian, Thomalla, Götz, Fiehler, Jens, Hanning, Uta
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7184052/
https://www.ncbi.nlm.nih.gov/pubmed/31997037
http://dx.doi.org/10.1007/s00415-020-09719-1
_version_ 1783526539443306496
author Schönfeld, Michael H.
Kabiri, Reza
Kniep, Helge C.
Meyer, Lukas
Sedlacik, Jan
Ernst, Marielle
Broocks, Gabriel
Faizy, Tobias D.
Cheng, Bastian
Thomalla, Götz
Fiehler, Jens
Hanning, Uta
author_facet Schönfeld, Michael H.
Kabiri, Reza
Kniep, Helge C.
Meyer, Lukas
Sedlacik, Jan
Ernst, Marielle
Broocks, Gabriel
Faizy, Tobias D.
Cheng, Bastian
Thomalla, Götz
Fiehler, Jens
Hanning, Uta
author_sort Schönfeld, Michael H.
collection PubMed
description BACKGROUND AND AIM: 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. 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. RESULTS: Twenty-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. 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00415-020-09719-1) contains supplementary material, which is available to authorized users.
format Online
Article
Text
id pubmed-7184052
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Springer Berlin Heidelberg
record_format MEDLINE/PubMed
spelling pubmed-71840522020-04-29 Sub-angiographic peripheral emboli in high resolution DWI after endovascular recanalization Schönfeld, Michael H. Kabiri, Reza Kniep, Helge C. Meyer, Lukas Sedlacik, Jan Ernst, Marielle Broocks, Gabriel Faizy, Tobias D. Cheng, Bastian Thomalla, Götz Fiehler, Jens Hanning, Uta J Neurol Original Communication BACKGROUND AND AIM: 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. 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. RESULTS: Twenty-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. 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00415-020-09719-1) contains supplementary material, which is available to authorized users. Springer Berlin Heidelberg 2020-01-29 2020 /pmc/articles/PMC7184052/ /pubmed/31997037 http://dx.doi.org/10.1007/s00415-020-09719-1 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Original Communication
Schönfeld, Michael H.
Kabiri, Reza
Kniep, Helge C.
Meyer, Lukas
Sedlacik, Jan
Ernst, Marielle
Broocks, Gabriel
Faizy, Tobias D.
Cheng, Bastian
Thomalla, Götz
Fiehler, Jens
Hanning, Uta
Sub-angiographic peripheral emboli in high resolution DWI after endovascular recanalization
title Sub-angiographic peripheral emboli in high resolution DWI after endovascular recanalization
title_full Sub-angiographic peripheral emboli in high resolution DWI after endovascular recanalization
title_fullStr Sub-angiographic peripheral emboli in high resolution DWI after endovascular recanalization
title_full_unstemmed Sub-angiographic peripheral emboli in high resolution DWI after endovascular recanalization
title_short Sub-angiographic peripheral emboli in high resolution DWI after endovascular recanalization
title_sort sub-angiographic peripheral emboli in high resolution dwi after endovascular recanalization
topic Original Communication
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7184052/
https://www.ncbi.nlm.nih.gov/pubmed/31997037
http://dx.doi.org/10.1007/s00415-020-09719-1
work_keys_str_mv AT schonfeldmichaelh subangiographicperipheralemboliinhighresolutiondwiafterendovascularrecanalization
AT kabirireza subangiographicperipheralemboliinhighresolutiondwiafterendovascularrecanalization
AT kniephelgec subangiographicperipheralemboliinhighresolutiondwiafterendovascularrecanalization
AT meyerlukas subangiographicperipheralemboliinhighresolutiondwiafterendovascularrecanalization
AT sedlacikjan subangiographicperipheralemboliinhighresolutiondwiafterendovascularrecanalization
AT ernstmarielle subangiographicperipheralemboliinhighresolutiondwiafterendovascularrecanalization
AT broocksgabriel subangiographicperipheralemboliinhighresolutiondwiafterendovascularrecanalization
AT faizytobiasd subangiographicperipheralemboliinhighresolutiondwiafterendovascularrecanalization
AT chengbastian subangiographicperipheralemboliinhighresolutiondwiafterendovascularrecanalization
AT thomallagotz subangiographicperipheralemboliinhighresolutiondwiafterendovascularrecanalization
AT fiehlerjens subangiographicperipheralemboliinhighresolutiondwiafterendovascularrecanalization
AT hanninguta subangiographicperipheralemboliinhighresolutiondwiafterendovascularrecanalization