Abstract
Objective
In
acute ischemic stroke, patient outcomes can be improved by first-pass
successful recanalization of the occluded vessel. This study
investigated whether microcatheter position could influence the success
of first-pass recanalization.
Methods
We
retrospectively analyzed 59 consecutive acute ischemic stroke patients
who underwent intra-arterial thrombectomy with stent retrievers for
middle cerebral artery (M1) occlusion. Angiography findings obtained via
the first pass of the microcatheter were analyzed. The microcatheter
was considered to be inserted into M2 segments that gave rise to
parietal arteries (M2P) if the anterior or posterior parietal artery was
observed. Recanalization results were compared between patients with
and without microcatheter insertion into M2P. The angle and diameter of
vessels were measured using post-procedural magnetic resonance
angiography (MRA).
Results
The
rate of first-pass successful recanalization (modified thrombolysis in
cerebral infarction score of ≥2b) was significantly higher in patients
with microcatheter insertion into M2P than in those without (56% vs 22%,
p = 0.016). The number of passes was lower in patients with first-pass
microcatheter insertion into M2P than in those without (1.8±1.0 vs
2.5±1.5, p = 0.05). The mean diameter of M2P was significantly larger
than that of the other M2 (1.9±0.6 mm vs 1.7±0.5 mm, p = 0.035). The
M1/M2P angle was significantly smaller than that between M1 and the
other M2. (49±32° vs 67±31°, p = 0.006).
Conclusions
First-pass
microcatheter insertion into M2P may contribute to fast successful
recanalization in patients with M1 occlusion who undergo intra-arterial
thrombectomy using stent retrievers.
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