Factors Associated with Procedural Thromboembolisms after Mechanical Thrombectomy for Acute Ischemic Stroke

Abstract

Background and objective: Procedural thromboembolisms after mechanical thrombectomy (MT) for acute ischemic stroke has rarely been studied. We retrospectively evaluated factors associated with procedural thromboembolisms after MT using diffusion-weight imaging (DWI) within 2 days of MT. Materials and Methods: From January 2018 to March 2020, 78 patients with acute ischemic stroke who underwent MT were evaluated using DWI. Procedural thromboembolisms were defined as new cerebral infarctions in other territories from the occluded artery on DWI after MT. Results: Procedural thromboembolisms were observed on DWI in 16 patients (20.5%). Procedural thromboembolisms were associated with old age (73.8 ± 8.18 vs. 66.8 ± 11.2 years, p = 0.021), intravenous (IV) thrombolysis (12 out of 16 (75.0%) vs. 25 out of 62 (40.3%), p = 0.023), heparinization (4 out of 16 (25.0%) vs. 37 out of 62 (59.7%), p = 0.023), and longer procedural time (90.9 ± 35.6 vs. 64.4 ± 33.0 min, p = 0.006). Multivariable logistic regression analysis revealed that procedural thromboembolisms were independently associated with procedural time (adjusted odds ratio (OR); 1.020, 95% confidence interval (CI); 1.002–1.039, p = 0.030) and IV thrombolysis (adjusted OR; 4.697, 95% CI; 1.223–18.042, p = 0.024). The cutoff value of procedural time for predicting procedural thromboembolisms was ≥71 min (area under the curve; 0.711, 95% CI; 0.570–0.851, p = 0.010). Conclusions: Procedural thromboembolisms after MT for acute ischemic stroke are significantly associated with longer procedural time and IV thrombolysis. This study suggests that patients with IV thrombolysis and longer procedural time (≥71 min) are at a higher risk of procedural thromboembolisms after MT for acute ischemic stroke.

The efficacy and risk factors of mechanical thrombectomy for the treatment of vertebrobasilar artery occlusion: a single center study

“…This current study further confirmed the important role of age in the unsatisfactory outcomes and in-hospital mortality. In practice, the age of patients in our study was relatively young compared with some other studies (23,24). Sojka et al reported that the mortality after 90 days was as high as 47.4 % in acute ischemic stroke patients aged more than 90 years old (25).…”

Association of Aortic Arch Calcification on Chest X-ray with Procedural Thromboembolism after Mechanical Thrombectomy for Acute Ischemic Stroke

“…Complications after an MT for an AIS include a procedural hemorrhagic complication and procedural thromboembolism. When previous studies focused on the efficacy and safety of an MT for an AIS, recanalization was considered a primary outcome, and a procedural hemorrhagic complication was considered a safety outcome [ 1 , 15 ]. However, procedural thromboembolism has not been considered necessary during the MT for an AIS, because the purpose of an MT for an AIS is to achieve the recanalization of the occluded vessels.…”

“…A mechanical thrombectomy (MT) is a standard treatment for an acute ischemic stroke caused by large artery occlusion, due to its site specificity and high recanalization rates [1][2][3]. The endovascular approach has the advantage of faster and safer access to the cerebral arteries; however, it also has a risk of procedural thromboembolism [4][5][6].…”

“…The endovascular approach has the advantage of faster and safer access to the cerebral arteries; however, it also has a risk of procedural thromboembolism [ 4 , 5 , 6 ]. It is well known that diffusion-weighted imaging (DWI) shows multiple small asymptomatic lesions after endovascular treatment of cerebrovascular disease [ 1 , 4 , 5 , 6 , 7 ]. Most previous studies on procedural thromboembolism in neurointervention have focused on coil embolization and carotid artery stenting [ 4 , 7 , 8 ].…”

“…Most previous studies on procedural thromboembolism in neurointervention have focused on coil embolization and carotid artery stenting [ 4 , 7 , 8 ]. As the goal of an MT for an acute ischemic stroke (AIS) is to achieve rapid recanalization, procedural thromboembolism after an MT for an AIC is considered not as crucial as recanalization [ 1 ]. Therefore, procedural thromboembolism after an MT for an AIS has rarely been studied.…”