Exploring the relationship between embolic acute stroke distribution and supra-aortic vessel patency: key findings from an in vitro model study.

Autor:	Velasco Gonzalez A; Clinic for Radiology, Neuroradiology, University of Münster and University Hospital of Münster, Münster, Germany velascoa@uni-muenster.de., Sauerland C; Institute of Biostatistics and Clinical Research, University of Münster, Munster, Germany., Görlich D; Institute of Biostatistics and Clinical Research, University of Münster, Munster, Germany., Ortega-Quintanilla J; Interventional Neuroradiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain., Jeibmann A; Institute of Neuropathology, University of Münster, Munster, Germany., Faldum A; Institute of Biostatistics and Clinical Research, University of Münster, Munster, Germany., Paulus W; Institute of Neuropathology, University of Münster, Munster, Germany., Heindel W; Clinic for Radiology, Neuroradiology, University of Münster and University Hospital of Münster, Münster, Germany., Buerke B; Clinic for Radiology, Neuroradiology, University of Münster and University Hospital of Münster, Münster, Germany.
Jazyk:	angličtina
Zdroj:	Stroke and vascular neurology [Stroke Vasc Neurol] 2024 May 23. Date of Electronic Publication: 2024 May 23.
DOI:	10.1136/svn-2023-003024
Abstrakt:	Background: We investigated differences in intracranial embolus distribution through communicating arteries in relation to supra-aortic vessel (SAV) patency. Methods: For this experimental analysis, we created a silicone model of the extracranial and intracranial circulations using a blood-mimicking fluid under physiological pulsatile flow. We examined the sequence of embolus lodgment on injecting 104 frangible clot analogues (406 emboli) through the right internal carotid artery (CA) as SAV patency changed: (a) all SAV patent (baseline), (b) emboli from a CA occlusion, (c) emboli contralateral to a CA occlusion and (d) occlusion of the posterior circulation. The statistical analysis included a descriptive analysis of thrombi location after occlusion (absolute and relative frequencies). Sequences of occlusions were displayed in Sankey flow charts for the four SAV conditions. Associations between SAV conditions and occlusion location were tested by Fisher's exact test. Two-sided p values were compared with a significance level of 0.05. Results: The total number of emboli was 406 (median fragments/clot: 4 (IQR: 3-5)). Embolus lodgment was dependent on SAV patency (p<0.0001). In all scenarios, embolism lodging in the anterior cerebral artery (ACA) occurred after a previous middle cerebral artery (MCA) embolism (MCA first lodge: 96%, 100/104). The rate of ipsilateral ACA embolism was 28.9% (28/97) at baseline, decreasing significantly when emboli originated from an occluded CA (16%, 14/88). There were more bihemispheric embolisations in cases of contralateral CA occlusion (37%, 45/122), with bilateral ACA embolisms preceding contralateral MCA embolism in 56% of cases (14/25 opposite MCA and ACA embolism). Conclusions: All emboli in the ACA occurred after a previous ipsilateral MCA embolism. Bihemispheric embolisms were rare, except when there was a coexisting occlusion in either CA, particularly in cases of a contralateral CA occlusion. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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