Rahul Kumar
G S Neuroscience Clinic and Research Centre, Patna, Bihar, India
Introduction: Mechanical thrombectomy for ischemic stroke is the most effective technique to achieve recanalization. As with every reperfusion technique the risk of hemorrhage undermines the benefits from recanalization to some extent. Due to speed widespread availability and ease of interpretation CT scan is the method of choice to study post reperfusion hemorrhage.
Materials and Methods: Over a period of 6 months 11 patients suffering from anterior circulation large artery occlusion underwent mechanical thrombectomy. According to the protocol at our institution all the patients underwent CT scanning immediately post procedure 24 hours post procedure and 5 days post procedure and in between if the clinical status so necessitated. All patients underwent thrombectomy using the Solitaire Device.
Results: TICI2b or TICI3 flow was obtained in all the 11 patients. 4 patients developed hemorrhagic transformation of the infarcted region and decompressive surgery had to be performed in 2 patients. Age risk factors for stroke time of reperfusion and use of GPIIb/IIIa inhibitors were not significantly different among the 2 groups. 10 out of 11 patients demonstrated CSA's on the post procedure scans. The CSA's were of various patterns but none of the patterns demonstrated consistent association with hemorrhage.
Conclusions: CSA's are common after successful reperfusion. They do not reliably predict the risk of future hemorrhagic transformation. They are possibly secondary to the blood brain barrier becoming more permeable due to the ischemia induced foot process retraction of the Astrocytes. They most often resolve spontaneously between 24 to 48 hours post procedure.