Selected in American Journal of Neuroradiology by JITTAPIROMSAK Pakrit
Authors: Kaesmacher J, Boeckh-Behrens T, Simon S, Maegerlein C, Kleine JF, Zimmer C, Schirmer L, Poppert H, Huber T
Reference: AJNR Am J Neuroradiol. 2017 May;38(5):991-998
Published: May 2017
Mechanical thrombectomy may be the cause of distal emboli during procedure resulting in demoted effectiveness in recanalisation. Identification of risk factors may improve the results of this procedure.
The authors reviewed 85 cases of anterior circulation strokes with successfully retrieved clot by thrombectomy. They correlated younger age, easy–to-retrieve thrombi, and bridging thrombolysis as significant risk factors for periprocedural fragmentation. Higher amounts of neutrophil elastase positive cells in the thrombus were also associated with multiple emboli.
The results are reasonable, however, an interpretation of these results should be done cautiously. When the clot is interpreted as easy to retrieve, we usually do not spend extra-time for minor distal emboli as statistically found in this study. When the clot is interpreted as difficult, there could be much more cases with remained distal emboli which are excluded by this study (no clot successfully retrieved). The results of clot histology are marginally significant/non-significant. This amount of retrieved proximal clot may not represent any risk for distal emboli.
The power of clinical evidence
Mechanical thrombectomy for acute ischemic stroke with occlusion of the M2 segment of the middle cerebral artery: a meta-analysis
Time for a time window extension: Insights from late presenters in the ESCAPE trial