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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...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2020
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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 |
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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 |
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