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Vascular neurology
Application of optical coherence tomography in decision-making of post-thrombectomy adjunctive treatments
  1. Di Li1,
  2. Tao Tang2,
  3. Teng Hu1,
  4. Piotr Walczak3,
  5. Dheeraj Gandhi3,
  6. Shen Li2
  1. 1 Department of Neurointervention, Dalian Municipal Central Hospital, Dalian, Liaoning, China
  2. 2 Department of Neurology and Psychiatry, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
  3. 3 Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr Shen Li, Department of Neurology and Psychiatry, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; lishen{at}mail.ccmu.edu.cn; Dr Di Li, Department of Neurointervention, Dalian Municipal Central Hospital, Dalian, Liaoning, China; jzlidi{at}126.com

Abstract

An adult patient with acute basilar artery occlusion underwent mechanical thrombectomy. After complete reperfusion, a 70% residual stenosis of the proximal basilar artery was observed. Intravascular optical coherence tomography (OCT) identified lipid plaques with an intact fibrous cap and thrombus in the culprit lesion, indicating plaque erosion was the mechanism of in situ thrombosis. Adjunctive antiplatelet therapy rather than rescue interventions was pursued for its beneficial effects in acute coronary syndrome caused by plaque erosion. The patient had a 90-day modified Rankin Scale score of 0. OCT enables precise evaluation of vessel characteristics following thrombectomy, so may improve outcomes through subsequent tailored treatments.

  • Stroke
  • Thrombectomy
  • Stenosis
  • Plaque
  • Intervention

https://doi.org/10.1136/jnis-2022-019195

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    Footnotes

    • DL, TT and TH contributed equally.

    • Contributors DL, TT, TH, PW, DG, and SL substantially contributed to the conception and manuscript drafting of the work. DL and TH performed the operative procedure and data acquisition. TT, PW, DG, and SL assisted in data analysis and revising the work. DL, TT, TH, PW, DG, and SL provided final approval for the version to be published. DL, TT, TH, PW, DG, and SL acknowledge and maintain the integrity of the work investigated.

    • Funding This study was funded by National Natural Science Foundation of China (82171319), Central Committee Healthcare Project (2020YB64), and the Emergency Project of Beijing Shijitan Hospital (2019-JJ02).

    • Competing interests SL received research funding support from National Natural Science Foundation of China. SL and TT received research funding support from Central Committee Healthcare Project and Emergency Project of Beijing Shijitan Hospital. PW is secretary of the Society for Image-Guided Neurointerventions (SIGN), and holds equity in Ti-com, LLC and Intra-Art, LLC. DG received research grants from Focused Ultrasound Foundation, INSIGHTEC and MicroVention.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.