Optical coherence tomography imaging after endovascular thrombectomy for basilar artery occlusion: report of 3 cases

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  • 1 Division of Neurosurgery, Department of Surgery, University of Toronto;
  • 2 Sunnybrook Health Sciences Centre, Toronto;
  • 3 Division of Neurosurgery, Sunnybrook Hospital, University of Toronto;
  • 4 Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto;
  • 5 Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; and
  • 6 Bioengineering and Biophotonics Laboratory, Toronto, Ontario, Canada
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Studies evaluating individuals for endothelial injury after endovascular thrombectomy (EVT) have been done by means of retrieved human thrombus, MR vessel-wall imaging, and animal histopathological studies. These techniques have limitations, because MR imaging has insufficient spatial resolution to directly visualize endothelium, and histopathological examinations are performed ex vivo and are unable to provide real-time patterns of injury. The purpose of the current study was to obtain in vivo intraluminal imaging after EVT by using optical coherence tomography (OCT), examining for evidence of endothelial injury in real time.

Three consecutive patients with acute basilar artery occlusion underwent OCT imaging immediately after EVT. There were no complications and adequate images were obtained for all patients. Anatomical features of the vessel wall were discernible, including intima, media, adventitia, and internal/external elastic lamina. Basilar artery thick concentric plaque fibrosis was present, causing outward remodeling and loss of the internal/external lamina in certain regions. Evidence of significant residual thrombus was also visible, with mostly red thrombus present despite complete angiographic revascularization. The residual thrombus was not visible on CT, MR, or cerebral angiography and could certainly cause ongoing function-limiting strokes with occlusion of adjacent vital basilar perforators after EVT.

ABBREVIATIONS AOL = arterial occlusive lesion; ASA = aspirin; BA = basilar artery; BAO = basilar artery occlusion; CTA = CT angiography; EVT = endovascular thrombectomy; mRS = modified Rankin Scale; MRVW = magnetic resonance vessel wall; NIHSS = National Institutes of Health Stroke Scale; OCT = optical coherence tomography; TICI = thrombolysis in cerebral infarction.

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Contributor Notes

Correspondence Christopher R. Pasarikovski: University of Toronto, ON, Canada. chris.pasarikovski@mail.utoronto.ca.

INCLUDE WHEN CITING Published online August 23, 2019; DOI: 10.3171/2019.5.JNS191252.

Disclosures Dr. Black is a consultant for Novartis and Roche; has received support from GE Healthcare, Eli Lilly, Biogen Idec, Novartis, Genentech, Optina, and Roche for non–study-related clinical or research effort that she has overseen; and has received CME credits from Eli Lilly and Novartis.

  • 1

    Chueh JY, Wakhloo AK, Gounis MJ: Effectiveness of mechanical endovascular thrombectomy in a model system of cerebrovascular occlusion. AJNR Am J Neuroradiol 33:19982003, 2012

    • Search Google Scholar
    • Export Citation
  • 2

    Gao P, Gui L, Yang B, Krings T, Jiao L: Optical coherence tomography of spontaneous basilar artery dissection in a patient with acute ischemic stroke. Front Neurol 9:858, 2018

    • Search Google Scholar
    • Export Citation
  • 3

    Gounis MJ, Ughi GJ, Marosfoi M, Lopes DK, Fiorella D, Bezerra HG, : Intravascular optical coherence tomography for neurointerventional surgery. Stroke 50:218223, 2019

    • Search Google Scholar
    • Export Citation
  • 4

    Gounis MJ, Wakhloo AK, Chueh JY: Preclinical investigations for thrombectomy devices—does it translate to humans? Stroke 44 (6 Suppl 1):S7S10, 2013

    • Search Google Scholar
    • Export Citation
  • 5

    Jeong HG, Kim BJ, Yang MH, Han MK, Bae HJ, Lee SH: Stroke outcomes with use of antithrombotics within 24 hours after recanalization treatment. Neurology 87:9961002, 2016

    • Search Google Scholar
    • Export Citation
  • 6

    Pearson JD: Endothelial cell function and thrombosis. Best Pract Res Clin Haematol 12:329341, 1999

  • 7

    Pierot L, Soize S, Benaissa A, Wakhloo AK: Techniques for endovascular treatment of acute ischemic stroke: from intra-arterial fibrinolytics to stent-retrievers. Stroke 46:909914, 2015

    • Search Google Scholar
    • Export Citation
  • 8

    Power S, Matouk C, Casaubon LK, Silver FL, Krings T, Mikulis DJ, : Vessel wall magnetic resonance imaging in acute ischemic stroke: effects of embolism and mechanical thrombectomy on the arterial wall. Stroke 45:23302334, 2014

    • Search Google Scholar
    • Export Citation
  • 9

    Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, : 2018 Guidelines for the Early Management of Patients with Acute Ischemic Stroke: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke 49:e46e110, 2018

    • Search Google Scholar
    • Export Citation
  • 10

    Roth W, Morgello S, Goldman J, Mohr JP, Elkind MS, Marshall RS, : Histopathological differences between the anterior and posterior brain arteries as a function of aging. Stroke 48:638644, 2017

    • Search Google Scholar
    • Export Citation
  • 11

    Singh P, Doostkam S, Reinhard M, Ivanovas V, Taschner CA: Immunohistochemical analysis of thrombi retrieved during treatment of acute ischemic stroke: does stent-retriever cause intimal damage? Stroke 44:17201722, 2013

    • Search Google Scholar
    • Export Citation
  • 12

    Tearney GJ, Regar E, Akasaka T, Adriaenssens T, Barlis P, Bezerra HG, : Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation. J Am Coll Cardiol 59:10581072, 2012 (Erratum in J Am Coll Cardiol 59:1662, 2012)

    • Search Google Scholar
    • Export Citation
  • 13

    Teng D, Pannell JS, Rennert RC, Li J, Li YS, Wong VW, : Endothelial trauma from mechanical thrombectomy in acute stroke: in vitro live-cell platform with animal validation. Stroke 46:10991106, 2015

    • Search Google Scholar
    • Export Citation

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