Introduction Timing of recanalization and safety of endovascular thrombectomy are important factors determining the final clinical outcome of acute stroke interventions. Appropriate position of the aspirating catheter and placement of stent retrievers are of paramount importance to achieve both these goals. Microcatheter injection (MCI) is a simple yet effective method to confirm appropriate position of the microcatheters and also to evaluate the collateral circulations. In this study, we evaluated the MCI applications in our practice and how it affected the procedural management of our patients with acute stroke.
Methods In this retrospective study, 200 patients with middle cerebral artery occlusion who underwent acute intervention from March 2015 to August 2018 were enrolled. All the charts, peri-operative images including CT scans and MRIs, and endovascular interventions were reviewed.
Results Out of 200 enrolled patients, 122 were female. The average age was 68.8 years and 141 had a baseline modified Rankin Scale (mRS) of less than 3. MCI was used in 72 patients leading to microcatheter repositioning in 15 instances. Average NIHSS at 90 days was 24.6 while 57 patients had a mRS less than 3 at 3-month follow up. Procedural time was significantly shorter in the non-MCI group (48.2 min vs. 76.5, p<0.01), non-MCI was associated with significantly better TICI 2B/3 reperfusion (96.6% vs. 88.7%, p<0.05), and non-MCI patients had a significantly better 3-month clinical outcome of mRS ≤ 3 (48.5% vs. 46.7%, p<0.05). Of note, MCI did not increase risk of hemorrhagic conversion or post-procedural subarachnoid hemorrhage.
Conclusion Though MCI theoretically helps with appropriate microcatheter positioning across an occlusion during thrombectomy, it was used as a technique in only in 36.0% of the cases in our cohort. Our data supports that performing MCI in stroke thrombectomy is significantly associated with longer procedural times, lower rates of TICI 2B/3 reperfusion, and worse 90 day outcomes (mRS >3) compared to not performing MCI. Further prospective studies are warranted to evaluate if the MCI technique affects reperfusion and functional outcomes in endovascular patients.
Disclosures M. Nouri: None. J. Lee: None. J. Mocco: None. P. Singh: 6; C; Penumbra.
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