Microemboli After Successful Thrombectomy Do Not Affect Outcome but Predict New Embolic Events
| Autor: | Can Ozan Tan, Ayaz Khawaja, Karen Li, Steven K. Feske, Farzaneh A. Sorond, Pedro Castro, Elsa Azevedo, Faheem Sheriff, Henri Vaitkevicius, Maria Angela Franceschini, Andrew D. Monk, Mariana Diz-Lopes, Sarah La Rose Michaud |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Ultrasonography Doppler Transcranial Embolism Infarction Article Brain Ischemia Postoperative Complications Modified Rankin Scale Interquartile range Internal medicine medicine.artery medicine Humans Prospective Studies Stroke Aged Thrombectomy Aged 80 and over Advanced and Specialized Nursing business.industry Endovascular Procedures Hazard ratio Middle Aged medicine.disease Transcranial Doppler Middle cerebral artery Cardiology Female Neurology (clinical) Cardiology and Cardiovascular Medicine business |
| Zdroj: | Stroke. 51:154-161 |
| ISSN: | 1524-4628 0039-2499 |
| DOI: | 10.1161/strokeaha.119.025856 |
| Popis: | Background and Purpose— We aimed to determine if microemboli after endovascular thrombectomy correlate with unfavorable outcomes despite successful recanalization. Methods— This is a prospective multicenter study of consecutive patients with ischemic stroke and occlusion of anterior circulation vessels (terminal internal carotid or main trunk of the middle cerebral artery/first-order branch of the main trunk of the middle cerebral artery segments of middle cerebral artery) after successful thrombectomy (modified Treatment In Cerebral Ischemia grades 2b-3). Microembolic signals (MES) were assessed by 30 minutes of transcranial Doppler monitoring within 72 hours of the last-seen-well time. Major outcomes included modified Rankin Scale at 90 days and infarct volume on head computed tomography at 24 hours. We also assessed early outcomes based on National Institutes of Health Stroke Scale variation and recurrence of stroke, transient ischemic attack, or systemic embolism within 90 days. Results— Among 111 patients, MES were detected in 43 (39%), with a median rate of 4 counts/h (interquartile range 2–12). The occurrence of MES was not associated with a significant difference in modified Rankin Scale (ordinal shift analysis, adjusted odds ratio, 1.06 [95% CI, 0.48–2.34] P =0.85) nor in functional independence (modified Rankin Scale, 0–2: adjusted odds ratio, 0.52 [95% CI, 0.19–1.39] P =0.19). Patients with and without MES had similar infarct volumes (adjusted beta, 11.2 [95% CI, −46.6 to +22.9] P =0.51) on 24-hour computed tomography. MES did predict new embolic events (adjusted Cox hazard ratio, 6.78 [95% CI, 1.63–27.8] P =0.01). Conclusions— MES detected by transcranial Doppler following endovascular treatment of anterior circulation occlusions do not predict clinical or radiological outcome. However, such emboli are an independent marker of recurrent embolic events within 90 days. |
| Databáze: | OpenAIRE |
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