Surveillance Cerebral Angiogram in None Target Vessels Following Mechanical Thrombectomy in Acute Ischemia Stroke

Introduction: Mechanical thrombectomy (MT) is the standard of care for patients presenting with acute ischemic stroke (AIS) and large vessel occlusion (LVO). This study aimed to assess the yield of surveillance angiogram following MT.

Methods: All consecutive patients presented with AIS and treated with MT from January 2019 to December 2020 in our comprehensive stroke center were included in the study and retrospectively reviewed. Demographics, LVO location, preoperative imaging findings, clinical data, reperfusion scores, fluoroscopy time, radiation exposure, contrast dose, NIHS scale, complication rate, baseline and follow up mRS were recorded. The decision to perform complete surveillance angiogram following MT was at the discretion of the neurointerventionalist.

Results: Total of 225 patients were included. Median age was 68 years. MT was done for anterior and posterior circulation LVO in 204 (90%) and 21 (9.3%) patients, respectively. Patients who underwent surveillance angiogram in none-target vessels following MT were 77 (28.9%). Additional surveillance angiogram findings were identified in 16 (7.1%) patients, in which 11 (4.8%) were not reported on preoperative CT angiogram. Change in management plan occurred in 8 (3.5%) patients based on surveillance angiogram only. This includes clinic follow up for 6 (2.6%) patients, scheduled gamma knife treatment in one (0.4%) patient with cerebellar AVM, elective right carotid endarterectomy in a patient with left M1 LVO, and MT for left M3 occlusion in a patient presented with right M1 LVO. Average radiation exposure was higher in surveillance group by 566 mGy, as well as fluoroscopy time (6 minutes) and contrast amount (28 cc). No additional complications were identified in surveillance angiogram group.

Conclusion : Surveillance angiogram following MT identified abnormal findings that were not reported in preoperative CTA in 4.8% of patients. Change in management plan based on these findings was done in 3.5% of the patients.