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Does Mechanical Thrombectomy in Acute Embolic Stroke Have Long-term Side Effects on Intracranial Vessels? An Angiographic Follow-up Study

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Abstract

Purpose

Mechanical thrombectomy (mTE) proved to be effective treating acute vessel occlusions with an acceptable rate of procedural complications. Potential long-term side effects of the vessel wall trauma caused by mechanical irritation of the endothelium are unknown up to now.

Methods

From a retrospectively established database of 640 acute stroke treatments, we selected 261 patients with 265 embolic vessel occlusions treated successfully by mTE without permanent implantation of a stent. Analysis comprised the type of devices used and the number of passes performed. Digital subtraction angiography immediately after treatment was evaluated for vasospasm, dissection, and extravasation. Control angiographic images were evaluated for any morphological change compared to the immediate posttreatment angiographic run.

Results

Recanalization was achieved with a median of one (range 1–10) mTE maneuvers. Vasospasm occurred in 69 territories (26.0 %) and was treated with glyceroltrinitrate in three. Dissection was observed in one vessel (0.4 %). Intraprocedural hemorrhage in two patients (0.8 %) was either wire or device induced. Follow-up digital subtraction angiography was available for 117 territories after a median of 107 days, revealing target vessel occlusion in one segment (0.9 %) and a de novo stenosis of four segments (3.4 %). All findings were clinically asymptomatic. Posttreatment vasospasm was more frequent in patients with de novo stenosis and occlusion (p = 0.038).

Conclusion

De novo stenoses and occlusions occur in a small proportion of patients after mTE. Because all lesions were clinically asymptomatic, this finding does not affect the overall benefit of the treatment. Vasospasm may predict late vessel wall changes.

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Conflict of interest

W. Kurre is a consultant to Phenox, received travel expenses from Phenox, and received speaker honoraria from Codman and Shurtleff Inc. M. Aguilar-Pérez is a consultant to Phenox. D. Horvath does not have any conflict of interest. E. Schmid received speaker honoraria from Bayer vital. H. Bäzner received speaker honoraria from Bayer vital, UCB Pharma, Biogen Idec and Boehringer Ingelheim. H. Henkes received speaker honoraria as well as travel expenses from Covidien/ev3 and Codman and Shurtleff Inc. He was cofounder of Dendron (the company that developed the Solitaire and was later acquired by ev3) and Phenox (the company that developed the pREset retriever).

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Authors and Affiliations

  1. Klinik für Diagnostische und Interventionelle Neuroradiologie, Klinikum Stuttgart, Kriegsbergstrasse 60, 70174, Stuttgart, Germany

    Wiebke Kurre, Marta Aguilar Pérez, Diana Horvath & Hans Henkes

  2. Neurologische Klinik, Klinikum Stuttgart, Tunzhofer Strasse 14-16, 70191, Stuttgart, Germany

    Elisabeth Schmid & Hansjörg Bäzner

  3. Medizinische Fakultät der Universität Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany

    Hans Henkes

Authors
  1. Wiebke Kurre
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  2. Marta Aguilar Pérez
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  3. Diana Horvath
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  4. Elisabeth Schmid
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  5. Hansjörg Bäzner
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  6. Hans Henkes
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Correspondence to Hans Henkes.

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Kurre, W., Pérez, M.A., Horvath, D. et al. Does Mechanical Thrombectomy in Acute Embolic Stroke Have Long-term Side Effects on Intracranial Vessels? An Angiographic Follow-up Study. Cardiovasc Intervent Radiol 36, 629–636 (2013). https://doi.org/10.1007/s00270-012-0496-8

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  • DOI: https://doi.org/10.1007/s00270-012-0496-8

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