Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
J Neurol. 2020 May;267(5):1401-1406. doi: 10.1007/s00415-020-09719-1. Epub 2020 Jan 29.
To analyze the incidence of peripheral emboli after successful mechanical thrombectomy (MT) of intracranial large vessel occlusions (LVO).
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.
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.
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.
分析颅内大血管闭塞（LVO）患者成功机械血栓切除（MT）后发生外周栓塞的发生率。
我们对接受颅内 LVO 成功 MT 治疗且在干预后第 1 天接受包括扩散加权成像（DWI）的 1.5T MRI 的患者进行了前瞻性分析，标准和高分辨率以及磁敏感加权成像（SWI）。使用扩展血栓溶解脑梗死（eTICI）量表在血栓切除后数字减影血管造影（DSA）上评估再灌注程度。将 DWI 核心病变远端的点状 DWI 病变归类为外周栓塞。将原发性受累血管区域外的 DWI 病变归类为新区域的栓塞。此外，分析了 SWI 和血栓切除后 DSA，并与 DWI 结果相关联。
28 例成功 MT 的患者符合纳入标准。在 28 例患者中（93%），共在 DWI 上检测到 324 个栓塞病变，占累积缺血核心体积的 2.1%。在标准分辨率 DWI 上检测到 151 个外周栓塞，在高分辨率 DWI 上又检测到 173 个额外的栓塞。9 例 eTICI 3 再灌注患者中有 8 例（29 个 DWI 病变）有栓塞病变。在未受 LVO 影响的血管区域观察到 9.6%（31/324）的外周栓塞。在接近 10.2%（33/324）的 DWI 病变处观察到 SWI 病变。
即使完全再灌注，MT 后外周栓塞也很常见。这些栓塞更常发生在闭塞血管的血管区域，而不是其他区域。很大一部分外周栓塞仅通过高分辨率 DWI 检测到。
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