J Pfaff1, C Herweh2, M Pham2, S Schieber3, P A Ringleb3, M Bendszus2, M Möhlenbruch2. 1. From the Departments of Neuroradiology (J.P., C.H., M.P., M.B., M.M.) johannes.pfaff@med.uni-heidelberg.de. 2. From the Departments of Neuroradiology (J.P., C.H., M.P., M.B., M.M.). 3. Neurology (S.S., P.A.R.), University of Heidelberg, Heidelberg, Germany.
Abstract
BACKGROUND AND PURPOSE: Patients with acute ischemic stroke in the anterior circulation are at risk for either primary or, following mechanical thrombectomy, secondary occlusion of the anterior cerebral artery. Because previous studies had only a limited informative value, we report our data concerning the frequency and location of distal anterior cerebral artery occlusions, recanalization rates, periprocedural complications, and clinical outcome. MATERIALS AND METHODS: We performed a retrospective analysis of prospectively collected data of patients with acute ischemic stroke undergoing mechanical thrombectomy in the anterior circulation between June 2010 and April 2015. RESULTS: Of 368 patients included in this analysis, we identified 30 (8.1%) with either primary (n = 17, 4.6%) or secondary (n = 13, 3.5%) embolic occlusion of the distal anterior cerebral artery. The recanalization rate after placement of a stent retriever was 88%. Periprocedural complications were rare and included vasospasms (n = 3, 10%) and dissection (n = 1, 3.3%). However, 16 (53.5%) patients sustained an (at least partial) infarction of the anterior cerebral artery territory. Ninety days after the ictus, clinical outcome according to the modified Rankin Scale score was the following: 0-2, n = 11 (36.6%); 3-4, n = 9 (30%); 5-6, n = 10 (33.3%). CONCLUSIONS: Occlusions of the distal anterior cerebral artery affect approximately 8% of patients with acute ischemic stroke in the anterior circulation receiving mechanical thrombectomy. Despite a high recanalization rate and a low complication rate, subsequent (partial) infarction in the anterior cerebral artery territory occurs in approximately half of patients. Fortunately, clinical outcome appears not to be predominately unfavorable.
BACKGROUND AND PURPOSE:Patients with acute ischemic stroke in the anterior circulation are at risk for either primary or, following mechanical thrombectomy, secondary occlusion of the anterior cerebral artery. Because previous studies had only a limited informative value, we report our data concerning the frequency and location of distal anterior cerebral artery occlusions, recanalization rates, periprocedural complications, and clinical outcome. MATERIALS AND METHODS: We performed a retrospective analysis of prospectively collected data of patients with acute ischemic stroke undergoing mechanical thrombectomy in the anterior circulation between June 2010 and April 2015. RESULTS: Of 368 patients included in this analysis, we identified 30 (8.1%) with either primary (n = 17, 4.6%) or secondary (n = 13, 3.5%) embolic occlusion of the distal anterior cerebral artery. The recanalization rate after placement of a stent retriever was 88%. Periprocedural complications were rare and included vasospasms (n = 3, 10%) and dissection (n = 1, 3.3%). However, 16 (53.5%) patients sustained an (at least partial) infarction of the anterior cerebral artery territory. Ninety days after the ictus, clinical outcome according to the modified Rankin Scale score was the following: 0-2, n = 11 (36.6%); 3-4, n = 9 (30%); 5-6, n = 10 (33.3%). CONCLUSIONS: Occlusions of the distal anterior cerebral artery affect approximately 8% of patients with acute ischemic stroke in the anterior circulation receiving mechanical thrombectomy. Despite a high recanalization rate and a low complication rate, subsequent (partial) infarction in the anterior cerebral artery territory occurs in approximately half of patients. Fortunately, clinical outcome appears not to be predominately unfavorable.
Authors: L C S Souza; A J Yoo; Z A Chaudhry; S Payabvash; A Kemmling; P W Schaefer; J A Hirsch; K L Furie; R G González; R G Nogueira; M H Lev Journal: AJNR Am J Neuroradiol Date: 2012-03-01 Impact factor: 3.825
Authors: Sibylle Stampfl; Christoph Kabbasch; Marguerite Müller; Anastasios Mpotsaris; Marc Brockmann; Thomas Liebig; Martin Wiesmann; Martin Bendszus; Markus A Möhlenbruch Journal: J Neurointerv Surg Date: 2015-05-29 Impact factor: 5.836
Authors: Olvert A Berkhemer; Puck S S Fransen; Debbie Beumer; Lucie A van den Berg; Hester F Lingsma; Albert J Yoo; Wouter J Schonewille; Jan Albert Vos; Paul J Nederkoorn; Marieke J H Wermer; Marianne A A van Walderveen; Julie Staals; Jeannette Hofmeijer; Jacques A van Oostayen; Geert J Lycklama à Nijeholt; Jelis Boiten; Patrick A Brouwer; Bart J Emmer; Sebastiaan F de Bruijn; Lukas C van Dijk; L Jaap Kappelle; Rob H Lo; Ewoud J van Dijk; Joost de Vries; Paul L M de Kort; Willem Jan J van Rooij; Jan S P van den Berg; Boudewijn A A M van Hasselt; Leo A M Aerden; René J Dallinga; Marieke C Visser; Joseph C J Bot; Patrick C Vroomen; Omid Eshghi; Tobien H C M L Schreuder; Roel J J Heijboer; Koos Keizer; Alexander V Tielbeek; Heleen M den Hertog; Dick G Gerrits; Renske M van den Berg-Vos; Giorgos B Karas; Ewout W Steyerberg; H Zwenneke Flach; Henk A Marquering; Marieke E S Sprengers; Sjoerd F M Jenniskens; Ludo F M Beenen; René van den Berg; Peter J Koudstaal; Wim H van Zwam; Yvo B W E M Roos; Aad van der Lugt; Robert J van Oostenbrugge; Charles B L M Majoie; Diederik W J Dippel Journal: N Engl J Med Date: 2014-12-17 Impact factor: 91.245
Authors: J Pfaff; C Herweh; M Pham; S Schönenberger; S Nagel; P A Ringleb; M Bendszus; M Möhlenbruch Journal: AJNR Am J Neuroradiol Date: 2016-06-30 Impact factor: 3.825
Authors: Seong-Joon Lee; Yang-Ha Hwang; Ji Man Hong; Jin Wook Choi; Dong-Hun Kang; Yong-Won Kim; Yong-Sun Kim; Jeong-Ho Hong; Joonsang Yoo; Chang-Hyun Kim; Bruce Ovbiagele; Andrew Demchuk; Sung-Il Sohn; Jin Soo Lee Journal: Sci Rep Date: 2020-11-30 Impact factor: 4.379
Authors: Shao Ju Shao; Guo Zhen Zhang; Long Zhao; Fa Rong Huo; Hong Bin Ma; Ling Zhu; Zhi Qi Yang; Rong Yin Journal: Medicine (Baltimore) Date: 2020-07-24 Impact factor: 1.817