Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Nov 15;61(11):640-646.
doi: 10.2176/nmc.oa.2021-0137. Epub 2021 Aug 23.

Difference of Thrombus Location between Initial Noninvasive Vascular Image and First DSA Findings in Mechanical Thrombectomy for Intracranial Large Vessel Occlusion: Post Hoc Analysis of the SKIP Study

Tetsuhiro Higashida  1 , Ryuzaburo Kanazawa  1 , Takanori Uchida  1 , Yuichi Takahashi  1 , Kentaro Suzuki  2 , Kazumi Kimura  2
Affiliations

Difference of Thrombus Location between Initial Noninvasive Vascular Image and First DSA Findings in Mechanical Thrombectomy for Intracranial Large Vessel Occlusion: Post Hoc Analysis of the SKIP Study

Tetsuhiro Higashida et al. Neurol Med Chir (Tokyo). .

Abstract

In patients who undergo mechanical thrombectomy for intracranial large vessel occlusion, the occluded site is sometimes distal to the site shown in the initial vascular imaging. We investigated the factors related to the change in the occluded site between the sequential imagings. The 203 patients in the SKIP study were reviewed retrospectively. Magnetic resonance angiography (MRA) or computed tomography angiography (CTA) was used to assess the occluded site. The occluded site shown in the cerebral angiography appeared to be distal to the occluded site shown in the initial vascular imaging in 55 patients (group A). The location of the occluded site in the remaining 148 patients did not change between the sequential imagings (group B). MRA was used more often than CTA in group A (54 MRA, 1 CTA; P <0.01). Patients with middle cerebral artery (M1) occlusion were more likely to show change of the occluded site than patients with internal carotid artery (ICA) occlusion (M1: 38%, ICA: 9%; P <0.01). The number of patients who received intravenous recombinant tissue plasminogen activator did not differ between the two groups (group A: 54%, group B: 49%; P = 0.5). In patients with acute intracranial large vessel occlusion who require mechanical thrombectomy, physicians should be aware that the location of the thrombus may be distal to the occluded site shown in the initial vascular imaging, particularly in patients with M1 occlusion shown by MRA.

Keywords: MRA; digital subtraction angiography; mechanical thrombectomy; middle cerebral artery.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
A representative case showing the discrepancy of the occluded site between noninvasive vascular imaging and DSA. MRA shows the signal loss at M1 segment of the middle cerebral artery (white arrow) (left). The occluded site is shown to be located at the M2 segment in subsequent DSA (black arrow) (right).
See this image and copyright information in PMC

References

    1. Goyal M, Menon BK, van Zwam WH, et al. : Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 387: 1723–1731, 2016 - PubMed
    1. Saver JL, Goyal M, Bonafe A, et al. : Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 372: 2285–2295, 2015 - PubMed
    1. Jovin TG, Chamorro A, Cobo E, et al. : Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 372: 2296–2306, 2015 - PubMed
    1. Goyal M, Demchuk AM, Menon BK, et al. : Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 372: 1019–1030, 2015 - PubMed
    1. Campbell BC, Mitchell PJ, Kleinig TJ, et al. : Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 372: 1009–1018, 2015 - PubMed

Substances