Patterns and Clinical Impact of Angiographically Visible Distal Emboli During Thrombectomy With Solitaire for Acute Ischemic Stroke

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Abstract

BACKGROUND:

Revascularization rates with stent retrievers after acute ischemic stroke are 69% to 86%, but favorable clinical outcomes occur in just 43% to 58% of cases. New distal emboli may negatively impact clinical outcomes.

OBJECTIVE:

To determine the prevalence and angiographic pattern of distal emboli associated with mechanical thrombectomy using the Solitaire Flow Restoration device and evaluate their correlation with clinical outcome.

METHODS:

We retrospectively reviewed the cerebral angiography of all patients with acute ischemic stroke who underwent mechanical thrombectomy with the use of the Solitaire FR device from 2012 to 2013. Angiographic microcatheter runs prior to Solitaire deployment and after thrombectomy were compared to identify new distal filling defects. Clinical outcome was assessed at discharge and after 90 days.

RESULTS:

Successful revascularization using the Solitaire device occurred in 36 of 39 patients (92%). Three distinct patterns were identified: new distal emboli in the same vascular territory (n = 3), new distal emboli in a new vascular territory (n = 3), and distal emboli that resolved after proximal revascularization (n = 7). Thirteen patients had distal emboli before and after Solitaire runs, and 13 showed no evidence of distal emboli. Favorable outcome (modified Rankin scores 0-2) was seen in 54% of all patients and 83% of patients with new distal emboli; thus, there was no correlation between new emboli and unfavorable clinical outcome (P = .67).

CONCLUSION:

We report an incidence rate of at least 15% of new emboli associated with use of the Solitaire device during thrombectomy in our series. Filling defects after Solitaire use were not associated with poor outcomes at discharge or 90-day follow-up.

ABBREVIATIONS:

ACA, anterior communicating artery

ABBREVIATIONS:

BA, basilar artery

ABBREVIATIONS:

BGC, balloon-guide catheter

ABBREVIATIONS:

ICA, internal carotid artery

ABBREVIATIONS:

IV, intravenous

ABBREVIATIONS:

MCA, middle cerebral artery

ABBREVIATIONS:

mRS, modified Rankin scale

ABBREVIATIONS:

NIHSS, National Institutes of Health Stroke Scale

ABBREVIATIONS:

TICI, Thrombolysis in Cerebral Infarction

ABBREVIATIONS:

tPA, tissue-type plasminogen activator

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