Title:Predictors of Emboli in Mechanical Thrombectomy for Anterior
Circulation Stroke
Volume: 21
Issue: 2
Author(s): Yongho Kwon, Ho Jun Yi*, Dong-Seong Shin and Bum-Tae Kim
Affiliation:
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
- Department
of Neurosurgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of
Korea
- Department of Neurosurgery, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea
Keywords:
Embolism, ischemic stroke, intervention, reperfusion, thrombectomy, clot retrieval.
Abstract:
Objective: Emboli commonly occurs in mechanical thrombectomy (MT). The objective
of this study was to analyze predicting factors of emboli after MT.
Methods: Patients who underwent MT with successful reperfusion for anterior circulation occlusion
were enrolled. Emboli included distal emboli at digital subtraction angiography (DSA) and
unexpected embolic infarct on diffusion-weighted image (DWI) without distal emboli at DSA.
Baseline characteristics, procedural details, angiographic outcomes, and clinical outcomes were
reviewed. Multivariable analyses were performed to evaluate predictive factors for the occurrence
of emboli.
Results: Of 601 patients, 149 (24.8%) patients had distal emboli at DSA, and 169 (28.1%) patients
had unexpected embolic infarction on DWI even without distal emboli at DSA. A total of
318 (52.9%) patients were enrolled in the embolic group, and 283 (47.1%) patients were assigned
to the non-embolic group. In multivariate analysis, larger microcatheter (OR 1.26, 95%
CI 1.12–1.94; p = 0.047), clot passage (OR 1.33, 95% CI 1.07–1.87; p = 0.041), use of balloon
guide catheter (BGC) (OR 0.70, 95% CI 0.52–0.92; p = 0.014), early ballooning of BGC (OR
0.68, 95% CI 0.50–0.90; p = 0.009), and longer stent retriever (OR 0.72, 95% CI 0.54–0.90; p =
0.029) were associated with occurrence of emboli.
Conclusion: MT with only a stent retriever, use of a larger microcatheter, and clot passage
might increase the risk of emboli. In contrast, contact aspiration thrombectomy, use of BGC,
early ballooning of BGC, and use of longer stent retrievers could reduce the chance of emboli.
