Influence of vessel morphology and variations on technical and clinical success in mechanical thrombectomy: -In vivo and in vitro analyses
| Autor: | Stefan Müller-Hülsbeck, Stephanie Lehrke, Silke Hopf-Jensen, Joana Marques, Michael Preiß |
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| Rok vydání: | 2018 |
| Předmět: |
Male
Middle Cerebral Artery Anterior Cerebral Artery Mechanical Thrombolysis Clinical success Models Biological 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine In vivo medicine Humans Radiology Nuclear Medicine and imaging Carotid Stenosis Thrombus Aged Radiological and Ultrasound Technology business.industry Infarction Middle Cerebral Artery Thrombosis medicine.disease Peripheral Mechanical thrombectomy Stenosis Treatment Outcome Embolism Vessel morphology cardiovascular system Female Neurology (clinical) business Nuclear medicine 030217 neurology & neurosurgery Carotid Artery Internal |
| Zdroj: | Journal of neuroradiology = Journal de neuroradiologie. 46(5) |
| ISSN: | 0150-9861 |
| Popis: | To determine the impact of vessel variation and anatomical features on technical and clinical success.In vitro blood clots (n=100) were introduced into a silicon carotid-T flow model of 2, 3 or 4mm. The ICA/M1angle varied at 45°, 90°, 135° and 180°. Peripheral embolism was measured. In vivo 50 pat. (73.5 yrs.,±15) with MCA occlusion were examined for siphon variation, ICA morphology, vessel diameter and angles. The patients were divided according to the clinical success (mRS): group A: mRS≤2 after 90 day and group B: mRS≥3. Furthermore the technical success (TICI) and number of retrieval (n) were analysed.In vitro with larger vessel diameter the migrated thrombus load decreased (P=.001). The steeper the M1/ICA angles, the higher thrombus weighs (180°: 2.94mg; 135°: 6.32mg; 90°: 8.65mg, 45°: 10.69mg; P.001). In vivo patients with mRS≤2 had significantly lower NIHSS (16.5 vs 20, P=.009) and higher ASPECTS (9 vs 6, P.05). TICI≥2b was more often achieved (86.6 vs 40% P=.002). The procedure time was lower (45 vs. 80min, P.05) with smaller number of retrieval (1.5 vs 4, P05). Proximal ICA stenosis offers a trend to unfavourable outcome (P=.073). Siphon variation "D" is associated with less retrieval manoeuvre.While in vitro there is a close correlation between embolism and vascular anatomy, in vivo carotid artery stenosis and siphon variation influence clinical and technical success. |
| Databáze: | OpenAIRE |
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