Background Distal emboli after thrombectomy are common. The purpose of this study was to determine factors associated with tissue infarction or survival in the territory of distal emboli.
Methods We reviewed clinical and imaging data from 358 patients with large vessel occlusions (LVOs) who underwent thrombectomies from 2015-2018. 71 patients were identified with distal emboli after thrombectomy and follow up MR imaging. All angiograms were reviewed for vessel diameter, emboli location, and presence of pial collaterals. Post-thrombectomy MR studies were reviewed for the presence of DWI changes in the expected territory of the emboli. Factors such as patient age, onset to treatment time, intravenous tPA administration, and pre-existing conditions were stratified by infarct presence and absence.
Results Distal emboli resulted in infarction in some or all the territory at risk in 46% (33/71) of patients. Chronic hypertension (p = 0.004) and pial collaterals (p = 2.5 x 10-8) were significantly associated with infarct presence and absence respectively. Patient age was not associated with development of infarct.
Conclusion The majority of distal emboli after thrombectomy do not result in tissue infarction. Poor pial collateral flow may be an indicator of patients that may benefit from additional mechanical or pharmacological treatments aimed at revascularization.
Disclosures E. Fuller: None. N. Fain: None. C. Zevallos: None. J. Vivanco Suarez: None. M. Hayakawa: None. K. Dlouhy: None. E. Samaniego: None. S. Ortega: None. C. Derdeyn: 2; C; Penumbra, Microvention, Silk Road, NoNO. 4; C; Pulse Therapeutics.
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