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.
ABBREVIATIONSAOL = 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.
Correspondence Christopher R. Pasarikovski: University of Toronto, ON, Canada. firstname.lastname@example.org.
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.
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