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

Restricted access

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.

Article Information

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.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    OCT imaging of the BA. A: Distal BA of case 1 appeared normal. Inset: Intima (green arrowhead), media (yellow asterisk) and adventitia (red arrowhead) were all discernible. The internal (purple arrowhead) and external (blue arrowhead) elastic lamina was also visible. A perforator was also visible (orange arrow). B: Distal BA of case 2 appeared normal with visible perforators (orange arrows). C: The OCT catheter positioned in the BA such that the optical lens marker was beyond the arterial region of interest. A cross-section is shown depicting residual thrombus (light blue arrow), patent perforator (orange arrow), and thrombosed perforator (dark blue arrow). White asterisks denote the wire and the shadow produced from the wire. Panel C: copyright Christopher R. Pasarikovski. Published with permission.

  • View in gallery

    Case 1. Angiographic and OCT imaging. A: Angiogram demonstrating complete BAO (yellow arrows) and TICI grade 3 reperfusion after thrombectomy. B: Thick plaque fibrosis was present (red arrows) causing concentric outward remodeling and loss of normal vessel architecture, and no internal and external lamina. C and D: Significant intraluminal red thrombus (light blue arrows) causing signal attenuation (green arrows) beyond the clot. Concentric fibrous plaque was present throughout the vessel wall (red arrows). White asterisks denote the wire and the shadow produced from the wire.

  • View in gallery

    Case 2. Angiographic and OCT imaging. A: Angiogram demonstrating complete proximal BAO (yellow arrows) and TICI grade 3 reperfusion after thrombectomy. B–D: Residual red thrombus (light blue arrows) with signal attenuation (green arrows) and white thrombus (yellow arrow) without signal attenuation. Thrombosed perforators (purple arrows) and open perforator (orange arrows) were visible. Fibrous plaque was present throughout (red arrow). White asterisks denote the wire and the shadow produced from the wire.

  • View in gallery

    Case 3. OCT imaging. A and B: BA appeared normal, with intima (green arrow), media (yellow asterisk), adventitia (red arrow), and internal elastic lamina (purple arrow) all discernible. A perforator was also visible (orange arrow). White asterisks denote the wire and the shadow produced from the wire.

  • View in gallery

    Cases 1 and 2. CTA and MRVW imaging. A: Coronal CTA of the BA (orange arrows) in case 1 displaying revascularization of the vessel with no luminal filling defect. B: Axial T1-weighted blood/CSF suppression sequence with gadolinium in case 1 displaying eccentric enhancement of the BA (yellow arrow). C: Coronal CTA of the BA (orange arrows) in case 2 again displaying revascularization of the vessel with no luminal filling defect. D: Axial T1-weighted blood/CSF suppression sequence with gadolinium administration in case 2 displaying more concentric enhancement of the BA (yellow arrow).

References

  • 1

    Chueh JYWakhloo AKGounis MJ: Effectiveness of mechanical endovascular thrombectomy in a model system of cerebrovascular occlusion. AJNR Am J Neuroradiol 33:199820032012

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2

    Gao PGui LYang BKrings TJiao L: Optical coherence tomography of spontaneous basilar artery dissection in a patient with acute ischemic stroke. Front Neurol 9:8582018

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3

    Gounis MJUghi GJMarosfoi MLopes DKFiorella DBezerra HG: Intravascular optical coherence tomography for neurointerventional surgery. Stroke 50:2182232019

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4

    Gounis MJWakhloo AKChueh JY: Preclinical investigations for thrombectomy devices—does it translate to humans? Stroke 44 (6 Suppl 1):S7S102013

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5

    Jeong HGKim BJYang MHHan MKBae HJLee SH: Stroke outcomes with use of antithrombotics within 24 hours after recanalization treatment. Neurology 87:99610022016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Pearson JD: Endothelial cell function and thrombosis. Best Pract Res Clin Haematol 12:3293411999

  • 7

    Pierot LSoize SBenaissa AWakhloo AK: Techniques for endovascular treatment of acute ischemic stroke: from intra-arterial fibrinolytics to stent-retrievers. Stroke 46:9099142015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Power SMatouk CCasaubon LKSilver FLKrings TMikulis DJ: Vessel wall magnetic resonance imaging in acute ischemic stroke: effects of embolism and mechanical thrombectomy on the arterial wall. Stroke 45:233023342014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Powers WJRabinstein AAAckerson TAdeoye OMBambakidis NCBecker 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:e46e1102018

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10

    Roth WMorgello SGoldman JMohr JPElkind MSMarshall RS: Histopathological differences between the anterior and posterior brain arteries as a function of aging. Stroke 48:6386442017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Singh PDoostkam SReinhard MIvanovas VTaschner CA: Immunohistochemical analysis of thrombi retrieved during treatment of acute ischemic stroke: does stent-retriever cause intimal damage? Stroke 44:172017222013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Tearney GJRegar EAkasaka TAdriaenssens TBarlis PBezerra 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 59:105810722012 (Erratum in J Am Coll Cardiol 59:1662 2012)

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13

    Teng DPannell JSRennert RCLi JLi YSWong VW: Endothelial trauma from mechanical thrombectomy in acute stroke: in vitro live-cell platform with animal validation. Stroke 46:109911062015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 636 636 610
Full Text Views 54 54 50
PDF Downloads 35 35 34
EPUB Downloads 0 0 0

PubMed

Google Scholar