Search

Background and Purpose— The aim of this prospective study was to assess vascular integrity after stent-retriever thrombectomy. Methods— Dissection, contrast medium extravasation, and vasospasm were evaluated in 23 patients after thrombectomy with biplane or 3D-digital subtraction angiography and 3-Tesla vessel wall MRI. Results— Vasospasm was detected angiographically in 10 patients, necessitating intra-arterial nimodipine in 2 of them. Contrast extravasation, intramural hemorrhage, or iatrogenic dissection were not detected on multimodal MRI in any patient even after Y-double stent-retriever technique. Conclusions— Our findings suggest that clinically relevant vessel wall injuries occur rarely after stent-retriever thrombectomy.

A 32-year-old man without previous medical problems had acute global aphasia and right-sided hemiplegia (National Institutes of Health Stroke Scale [NIHSS] score 16 points) shortly after carrying a heavy mirror. Smoking (8 pack-years) was his only vascular risk factor. Computed tomographic angiography demonstrated a left carotid T occlusion (occlusion of the carotid artery, middle and anterior cerebral artery). Ninety minutes after symptom onset, intravenous thrombolysis was initiated with 80 mg recombinant tissue-type plasminogen activator, but successful reperfusion (Thrombolysis in Cerebral Infarction scale 3) was achieved only after thrombectomy with a Solitaire Stent (puncture 236 minutes and reperfusion 263 minutes after symptom onset). The thrombus was 20 mm long. Immediately after the intervention, his symptoms started to improve, and head MRI on the day after showed a residual 3.5 cm×1.5 cm×1.5 cm lesion in the left-sided basal ganglia on diffusion weighted imaging and that the recanalized carotid T stayed open (Figure 1). Secondary prevention with aspirin 100 mg/d and atorvastatin 40 mg/d was initiated. The sudden onset of physical straining and the large thrombus were suspicious for a cardioembolic source. Admission and follow-up ECG, 24-hour ECG recordings, and transesophageal echocardiography were normal. The only abnormalities of ancillary investigations were borderline-elevated high-sensitivity troponin T (hs troponin T; 0.015 μg/L; normal value 3-fold elevated creatine kinase levels (750 U/L; normal value

Background and Purpose— The question whether cerebral microbleeds (CMBs) visible on MRI in acute stroke increase the risk for intracerebral hemorrhages (ICHs) or worse outcome after thrombolysis is unresolved. The aim of this study was to analyze the impact of CMB detected with pretreatment susceptibility-weighted MRI on ICH occurrence and outcome. Methods— From 2010 to 2013 we treated 724 patients with intravenous thrombolysis, endovascular therapy, or intravenous thrombolysis followed by endovascular therapy. A total of 392 of the 724 patients were examined with susceptibility-weighted MRI before treatment. CMBs were rated retrospectively. Multivariable regression analysis was used to determine the impact of CMB on ICH and outcome. Results— Of 392 patients, 174 were treated with intravenous thrombolysis, 150 with endovascular therapy, and 68 with intravenous thrombolysis followed by endovascular therapy. CMBs were detected in 79 (20.2%) patients. Symptomatic ICH occurred in 21 (5.4%) and asymptomatic in 75 (19.1%) patients, thereof 61 (15.6%) bleedings within and 35 (8.9%) outside the infarct. Neither the existence of CMB, their burden, predominant location nor their presumed pathogenesis influenced the risk for symptomatic or asymptomatic ICH. A higher CMB burden marginally increased the risk for ICH outside the infarct ( P =0.048; odds ratio, 1.004; 95% confidence interval, 1.000–1.008). Conclusions— CMB detected on pretreatment susceptibility-weighted MRI did not increase the risk for ICH or worsen outcome, even when CMB burden, predominant location, or presumed pathogenesis was considered. There was only a small increased risk for ICH outside the infarct with increasing CMB burden that does not advise against thrombolysis in such patients.

Background and Purpose— Stent retrievers have become an important tool for the treatment of acute ischemic stroke. The aim of this study was to analyze outcome and complications in a large cohort of patients with stroke treated with the Solitaire stent retriever. The study also included patients who did not meet standard inclusion criteria for endovascular treatment: low or high baseline National Institutes of Health Stroke Scale score, ≥80 years of age, extensive ischemic signs in middle cerebral artery territory, and time from symptom onset to endovascular intervention >8 hours. Methods— Consecutive patients with acute anterior circulation stroke treated with the Solitaire FR were analyzed. Data on characteristics of endovascular interventions, complications, and clinical outcome were collected prospectively. Patients who met standard inclusion criteria were compared with those who did not. Results— A total of 227 patients were included. Mean age was 68.2±14.7 years, and median National Institutes of Health Stroke Scale score on admission was 16 (range, 2–36). Reperfusion was successful (thrombolysis in cerebral infarction, 2b–3) in 70.9%. Outcome was favorable (modified Rankin Scale, 0–2) in 57.7% of patients who met standard inclusion criteria and 30.3% of those who did not. The rates for symptomatic intracranial hemorrhage were 3.7% and 13.1%, for death 11.4% and 33.8%, and for symptomatic intraprocedural complications 2.5% and 4.8%, respectively. Conclusions— Patients