High-resolution vessel wall imaging after mechanical thrombectomy

Kasab, Sami Al; Bathla, Girish; Varón, Alberto Rodríguez; Roa, Jorge A; Sabotin, Ryan; Raghuram, Ashrita; Wu, Chaorong; Hasan, David; Turan, Tanya N.; Chatterjee, Rano; Samaniego, Edgar A

doi:10.1177/19714009211017782

Cited by 10 publications

(8 citation statements)

References 29 publications

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“…We speculate that these changes are due to the aggressive nature of our testing, and such changes might be much milder or absent with a single or smaller number of punctures. Similar descriptions of vessel wall enhancement have been described in the clinical setting after mechanical thrombectomy from an ischemic stroke 23–25. Those studies suggest that unlike significant complications of mechanical thrombectomy, such as vessel dissections and thrombus, isolated vessel wall enhancement does not have associated morbidities and insignificant clinical implication at this time 16 21 26.…”

Section: Discussionsupporting

confidence: 60%

Endovascular transmural access to carotid artery perivascular tissues: safety assessment of a novel technique

Kim

Samarage

Zarrin

et al. 2022

J NeuroIntervent Surg

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BackgroundRecent advances in endovascular devices have allowed access and targeting of perivascular tissues of the peripheral circulation. The perivascular tissues of the cervical and cranial circulations have many important structures of clinical significance, yet the feasibility and safety of such an approach has not been demonstrated.ObjectiveTo evaluate the safety of a novel endovascular transmural approach to target the perivascular tissues of the common carotid artery in swine.MethodsA micro-infusion device was positioned in the carotid arteries of three Yorkshire pigs (six carotid arteries in total), and each carotid artery was punctured 10 times in the same location to gain access to the perivascular tissues. Digital subtraction angiography was used to evaluate vessel injury or contrast extravasation. MRI and MR angiography were used to evaluate evidence of cerebral ischemia or vessel injury. Post-mortem tissue analysis was performed to assess the level of extravascular hematoma and intravascular dissection.ResultsNone of the tested carotid arteries showed evidence of vessel injury (dissection or perforation) or intravascular thrombosis. MRI performed after repeated puncture was negative for neck hematoma and brain ischemia. Post-mortem tissue analysis of the carotid arteries showed mild adventitial staining with blood, but without associated hematoma and without vessel dissection.ConclusionRepeated puncture of the carotid artery to gain access to the perivascular tissues using a novel endovascular transmural approach is safe in a swine model. This represents a novel approach to various tissues in close proximity to the cervical and cranial vasculature.

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Section: Discussionsupporting

confidence: 60%

Endovascular transmural access to carotid artery perivascular tissues: safety assessment of a novel technique

Kim

Samarage

Zarrin

et al. 2022

J NeuroIntervent Surg

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“…21 Gadolinium contrast enhancement was observed irrespective of the device used; however, Kasab and colleagues suggested that the use of stent retrievers is associated with a higher enhancement as compared to aspiration catheters. 26 This arterial wall abnormality is less common among patients treated with medical therapy alone, suggesting that vessel wall enhancement is the result of the abrasive forces exerted by the devices rather than the thromboembolism itself. 21,25 The extracranial ICA (C1 or cervical carotid) travels through the carotid sheath until entering the skull through the carotid canal.…”

Section: Discussionmentioning

confidence: 97%

“…These arterial changes have been correlated with vessel wall thickening and contrast enhancement in MRI studies with high-resolution vessel wall imaging within 3 days and 3 months after MT. [21][22][23][24][25][26] The arterial wall thickening is explained by intima edema, whereas increased endothelial permeability to intravascular gadolinium would be responsible for the arterial wall enhancement. 21 Gadolinium contrast enhancement was observed irrespective of the device used; however, Kasab and colleagues suggested that the use of stent retrievers is associated with a higher enhancement as compared to aspiration catheters.…”

Section: Discussionmentioning

confidence: 99%

Orbital inflammatory syndrome after mechanical thrombectomy of acute carotid occlusion

Silva¹,

Costa²,

Pinto³

et al. 2022

JNSK

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Introduction: Orbital ischemic syndrome (OIS) is a rare disorder that presents with acute loss of visual acuity, chemosis, proptosis, ptosis and ophtalmoparesis. We present a case with acute onset of orbital inflammation following mechanical thrombectomy that mimicked an OIS, except for the absence of vision loss. Case report: A 65-year-old woman presented to our emergency department after an episode of transient dysarthria and left-sided hemiparesis and paresthesia that lasted about forty minutes. Head computed tomography showed no signs of intracranial bleeding or acute ischemia. CT angiogram showed occlusion of the right ICA terminus. Mechanical thrombectomy was then performed and the clot was removed with combined technique. Eight hours later, she developed orbital pain, ptosis, chemosis and complete ophthalmoplegia of the right eye. She had no diplopia, visual acuity and funduscopic examination were normal and there was no audible bruit in the orbit. Brain MRI performed showed hyperintensity of orbital fat along with hyperintensity and enlargement of all the extraocular There were no signs of orbital infarction and the optic nerve was structurally normal. Time of flight magnetic resonance angiography revealed reduced calibre of the distal portion of ICA, with associated contrast enhancement on vessel wall imaging. She was started on intravenous dexamethasone with full recovery two days later. Discussion: We present the case of an orbital inflammatory syndrome after mechanical thrombectomy. The mechanical stress exerted by endovascular devices has been associated with endothelial damage that correlates with vessel wall thickening and contrast enhancement in high resolution MRI studies. The temporal correlation with mechanical thrombectomy, the absence of vision loss or orbital infarction and the good clinical response to steroids support the hypothesis of an internal carotid artery wall inflammation due to endovascular manipulation of the stent retriever to be responsible for this acute orbital syndrome. This case highlights the need for close postprocedural monitoring after MT and the consideration of orbital inflammation secondary to endovascular devices in the differential diagnosis of an acute orbital syndrome. Further studies are needed to understand the long-term consequences of arterial wall lesions associated with these devices.

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“…Furthermore, plaque enhancement represents an independent predictor of stroke recurrence [ 34 , 36 ]. To avoid misdiagnosis, it is worth noting that T1W concentric enhancement of vessel wall may be detected after endovascular treatment [ 37 , 38 ].…”

Section: Clinical Applicationsmentioning

confidence: 99%

“…The use of diffusion weighted imaging (DWI) helps in depicting the area of ischemia [ 14 ]. Moreover, in acute stroke patients treated with mechanical thrombectomy, VWE often occurs, representing endothelial damage, inflammation and greater disruption of the blood–brain barrier caused by devices, and it is more pronounced with the use of stent retrievers, than aspiration catheters [ 37 ].…”

Section: Pitfallsmentioning

confidence: 99%

Vessel Wall Magnetic Resonance Imaging in Cerebrovascular Diseases

et al. 2022

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Cerebrovascular diseases are a leading cause of disability and death worldwide. The definition of stroke etiology is mandatory to predict outcome and guide therapeutic decisions. The diagnosis of pathological processes involving intracranial arteries is especially challenging, and the visualization of intracranial arteries’ vessel walls is not possible with routine imaging techniques. Vessel wall magnetic resonance imaging (VW-MRI) uses high-resolution, multiparametric MRI sequences to directly visualize intracranial arteries walls and their pathological alterations, allowing a better characterization of their pathology. VW-MRI demonstrated a wide range of clinical applications in acute cerebrovascular disease. Above all, it can be of great utility in the differential diagnosis of atherosclerotic and non-atherosclerotic intracranial vasculopathies. Additionally, it can be useful in the risk stratification of intracranial atherosclerotic lesions and to assess the risk of rupture of intracranial aneurysms. Recent advances in MRI technology made it more available, but larger studies are still needed to maximize its use in daily clinical practice.

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High-resolution vessel wall imaging after mechanical thrombectomy

Cited by 10 publications

References 29 publications

Endovascular transmural access to carotid artery perivascular tissues: safety assessment of a novel technique

Endovascular transmural access to carotid artery perivascular tissues: safety assessment of a novel technique

Orbital inflammatory syndrome after mechanical thrombectomy of acute carotid occlusion

Vessel Wall Magnetic Resonance Imaging in Cerebrovascular Diseases

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