Perren Fabienne, Kargiotis Odysseas, Pignat Jean-Michel, Pereira Vitor Mendes
HUG, University Hospital and Medical Faculty of Geneva, Department of Neurology, Neurovascular and Neurosonology Unit, Geneva, Switzerland.
Metropolitan Hospital, Athens, Greece.
J Neuroimaging. 2018 Jul;28(4):412-415. doi: 10.1111/jon.12513. Epub 2018 Apr 14.
Stent retrievers have revolutionized endovascular treatment of acute ischemic stroke (AIS). Animal studies showed that mechanical thrombectomy (MT) may cause endothelial injury and intimal layer edema. Using transcranial color-coded duplex-sonography (TCCS) we observed postprocedural hemodynamic changes in the treated vessel.
We studied AIS patients with large intracranial artery occlusion in whom MT with stent retrievers was performed. Only those with complete recanalization (modified TICI-2b or 3) as assessed by postprocedural digital subtraction angiography (DSA) and in whom early control TCCS was performed were retained. Patients treated with intra-arterial thrombolysis or stenting were excluded.
In 31 patients treated within a time period of 4 years (29 with middle cerebral artery [MCA] and 2 with basilar artery [BA] occlusion), postacute stroke brain-DSA confirmed complete recanalization without residual stenosis or vasospasm. However, in 27 (17 men, mean age 66.3 years) of them TCCS (mean 3.4 days after MT) showed very segmental acceleration of blood flow velocities in the affected arteries (MCA maximum peak systolic velocity [PSVmax] at least >35% as compared to the contralateral side at the same depth; BA PSVmax >40% as compared to velocities at different depths of the same vessel). None showed clinical deterioration. TCCS follow-up (mean 20 days) showed normalization in 14 of 16 cases.
Our TCCS study provides preliminary evidence of focal acceleration of blood flow velocities after MT. Without residual stenosis or vasospasm, this may be a sign of endothelial layer disruption/intimal injury. Further studies are needed to confirm our results.
取栓支架彻底改变了急性缺血性卒中（AIS）的血管内治疗。动物研究表明，机械取栓术（MT）可能会导致内皮损伤和内膜层水肿。我们使用经颅彩色编码双功超声检查（TCCS）观察了治疗后血管的血流动力学变化。
我们研究了接受取栓支架MT治疗的颅内大动脉闭塞的AIS患者。仅纳入那些术后数字减影血管造影（DSA）评估为完全再通（改良脑梗死溶栓分级[TICI]-2b或3级）且早期进行了对照TCCS检查的患者。排除接受动脉内溶栓或支架置入治疗的患者。
在4年时间内治疗的31例患者中（29例大脑中动脉[MCA]闭塞，2例基底动脉[BA]闭塞），急性卒中后脑DSA证实完全再通，无残余狭窄或血管痉挛。然而，其中27例（17例男性，平均年龄66.3岁）TCCS检查（MT后平均3.4天）显示，患侧动脉血流速度呈节段性加快（MCA最大收缩期峰值速度[PSVmax]与对侧相同深度相比至少>35%；BA的PSVmax与同一血管不同深度处的速度相比>40%）。无一例出现临床病情恶化。TCCS随访（平均20天）显示，16例中有14例血流速度恢复正常。
我们的TCCS研究为MT后血流速度的局灶性加快提供了初步证据。在无残余狭窄或血管痉挛的情况下，这可能是内皮细胞层破坏/内膜损伤的迹象。需要进一步研究来证实我们的结果。
