Journal article
Predictors of tissue infarction from distal emboli after mechanical thrombectomy
Journal of neurointerventional surgery, Vol.16(10), pp.959-965
10/2024
DOI: 10.1136/jnis-2023-020782
PMID: 37620130
Abstract
Background Distal embolization after endovascular thrombectomy (EVT) is common. We aimed to determine factors associated with tissue infarction in the territories of distal emboli. Methods This is a retrospective cohort study of consecutive patients with anterior circulation large vessel occlusions who underwent EVT from 2015 to 2021. Patients with Thrombolysis In Cerebral Infarction (TICI) 2b reperfusion and follow-up imaging were identified. Baseline characteristics, procedural details, and imaging findings were reviewed. Primary outcome was categorized according to the occurrence of infarction at the territory of distal embolus on follow-up diffusion-weighted imaging MRI. Results Of 156 subjects, 97 (62%) had at least one infarction in the territories at risk. Hypertension was significantly more prevalent in the infarct group (83% vs 53%, P=0.001). General anesthesia was more commonly used in the infarct group (60% vs 43%, P=0.037). The median number of distal emboli and diameter of the occluded vessel were similar. After adjusting for confounders, hypertension (aOR 4.73, 95% CI 1.81 to 13.25, P=0.002), higher blood glucose (aOR 1.01, 95% CI 1.00 to 1.03, P=0.023), and general anesthesia (aOR 2.75, 95% CI 1.15 to 6.84, P=0.025) were independently associated with infarction. The presence of angiographic leptomeningeal collaterals predicted tissue survival (aOR 0.13, 95% CI 0.05 to 0.33, P<0.001). 90-day modified Rankin scale (mRS) scores were worse for the infarction patients (mRS 0–2: infarct, 39% vs 55%, P=0.046). Conclusions Nearly 40% of patients with TICI 2b had no tissue infarction in the territory of a distal embolus. The association of infarction with hypertension and general anesthesia suggests late or post-procedural blood pressure management could be a modifiable factor. Patients with poor leptomeningeal collaterals or hyperglycemia may benefit from further attempts at revascularization.
Details
- Title: Subtitle
- Predictors of tissue infarction from distal emboli after mechanical thrombectomy
- Creators
- Emily Fuller - University of IowaJuan Vivanco-Suarez - University of IowaNicholas Fain - University of Iowa Hospitals and ClinicsCynthia Zevallos - University of IowaYujing LuSantiago Ortega-Gutierrez - University of Iowa Hospitals and ClinicsColin Derdeyn - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Journal of neurointerventional surgery, Vol.16(10), pp.959-965
- DOI
- 10.1136/jnis-2023-020782
- PMID
- 37620130
- NLM abbreviation
- J Neurointerv Surg
- ISSN
- 1759-8478
- eISSN
- 1759-8486
- Publisher
- BMJ Publishing Group LTD
- Language
- English
- Electronic publication date
- 08/24/2023
- Date published
- 10/2024
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984457959202771
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