Interv Neuroradiol
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Endovascular thrombectomy is recommended for a persistent ischemic penumbra if recanalization cannot be achieved by the intravenous (IV) administration of recombinant tissue-plasminogen activator (rt-PA) alone. Although endovascular thrombectomy is a powerful treatment for major cerebral artery occlusion, the monitoring of recanalization and reperfusion during acute ischemic stroke presents a therapeutic challenge, and a previous study reported the usefulness of near-infrared spectroscopy (NIRS) for intraoperative monitoring during emergency endovascular thrombectomy for acute large ischemic stroke. Here we present our experience with a relevant case series. ⋯ By contrast, in the patient with non-large ischemic stroke, the rSO2 did not change, despite complete recanalization of the distal MCA. Our findings suggest the limited usefulness of intraoperative NIRS monitoring during emergency endovascular thrombectomy for non-large acute ischemic stroke caused by a distal MCA occlusion. However, intraoperative NIRS monitoring could be used practically to detect recanalization of the major artery during thrombectomy and early IV rt-PA administration in cases involving major artery occlusion.
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Purpose The occurrence of thrombus migration (TM) in middle cerebral arteries (MCAs) prior to mechanical thrombectomy (MT) in patients suffering from acute ischemic strokes is a crucial aspect as TM is associated with lower rates of complete reperfusion and worse clinical outcomes. In this study, we sought to clarify whether histological thrombus composition influences TM. Methods We included 64 patients with acute MCA occlusions who had undergone MT. ⋯ A weak tendency for higher RBC and lower F/P content could be observed in thrombi that had migrated when compared with stable thrombi (RBC: median 41% vs 37%, p = 0.022 and F/P: median 54% vs 57%, p = 0.024). When using a cut-off of 60% RBC content for the definition of RBC-rich thrombi, a higher portion of RBC-rich thrombi could be identified in the migrated group as opposed to the stable group (36.4% vs 5.7%, p = 0.003). Conclusion Preinterventional TM may be influenced by the histological thrombus composition in a way that RBC-rich thrombi are more prone to migrate.