Microemboli After Successful Thrombectomy Do Not Affect Outcome but Predict New Embolic Events

BACKGROUND AND PURPOSE—We aimed to determine if microemboli after endovascular thrombectomy correlate with unfavorable outcomes despite successful recanalization. METHODS—This is a prospective multicenter study of consecutive patients with ischemic stroke and occlusion of anterior circulation vessel...

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Published in:	Stroke (1970) Vol. 51; no. 1; pp. 154 - 161
Main Authors:	Sheriff, Faheem, Diz-Lopes, Mariana, Khawaja, Ayaz, Sorond, Farzaneh, Tan, Can Ozan, Azevedo, Elsa, Franceschini, Maria Angela, Vaitkevicius, Henri, Li, Karen, Monk, Andrew Donald, Michaud, Sarah LaRose, Feske, Steven K., Castro, Pedro
Format:	Journal Article
Language:	English
Published:	United States American Heart Association, Inc 01-01-2020
Subjects:	Aged Aged, 80 and over Brain Ischemia - diagnostic imaging Brain Ischemia - epidemiology Brain Ischemia - surgery Embolism - diagnostic imaging Embolism - epidemiology Embolism - etiology Endovascular Procedures - adverse effects Female Humans Male Middle Aged Postoperative Complications - diagnostic imaging Postoperative Complications - epidemiology Postoperative Complications - etiology Prospective Studies Stroke - diagnostic imaging Stroke - epidemiology Stroke - surgery Thrombectomy - adverse effects Ultrasonography, Doppler, Transcranial infarction blood pressure embolism thrombectomy middle cerebral artery
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Summary:	BACKGROUND AND PURPOSE—We aimed to determine if microemboli after endovascular thrombectomy correlate with unfavorable outcomes despite successful recanalization. METHODS—This is a prospective multicenter study of consecutive patients with ischemic stroke and occlusion of anterior circulation vessels (terminal internal carotid or main trunk of the middle cerebral artery/first-order branch of the main trunk of the middle cerebral artery segments of middle cerebral artery) after successful thrombectomy (modified Treatment In Cerebral Ischemia grades 2b-3). Microembolic signals (MES) were assessed by 30 minutes of transcranial Doppler monitoring within 72 hours of the last-seen-well time. Major outcomes included modified Rankin Scale at 90 days and infarct volume on head computed tomography at 24 hours. We also assessed early outcomes based on National Institutes of Health Stroke Scale variation and recurrence of stroke, transient ischemic attack, or systemic embolism within 90 days. RESULTS—Among 111 patients, MES were detected in 43 (39%), with a median rate of 4 counts/h (interquartile range 2–12). The occurrence of MES was not associated with a significant difference in modified Rankin Scale (ordinal shift analysis, adjusted odds ratio, 1.06 [95% CI, 0.48–2.34] P=0.85) nor in functional independence (modified Rankin Scale, 0–2adjusted odds ratio, 0.52 [95% CI, 0.19–1.39] P=0.19). Patients with and without MES had similar infarct volumes (adjusted beta, 11.2 [95% CI, −46.6 to +22.9] P=0.51) on 24-hour computed tomography. MES did predict new embolic events (adjusted Cox hazard ratio, 6.78 [95% CI, 1.63–27.8] P=0.01). CONCLUSIONS—MES detected by transcranial Doppler following endovascular treatment of anterior circulation occlusions do not predict clinical or radiological outcome. However, such emboli are an independent marker of recurrent embolic events within 90 days.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 These authors contributed equally to the manuscript
ISSN:	0039-2499 1524-4628
DOI:	10.1161/STROKEAHA.119.025856