What is the real risk of dislodging thrombi during endovascular revascularization of a proximal XXXX occlusion?

@entity1 @entity887 @entity6455 @entity715 @entity12870
BACKGROUND:: There is a theoretical concern that a @entity715 may be dislodged distally when crossing the occluded segment during recanalization of a complete occlusion. OBJECTIVE:: To assess the immediate post-procedural brain diffusion weighted image (DWI) findings following endovascular recanalization using an embolic protection device for proximal internal carotid artery ( @entity6455 ) occlusion. MATERIALS AND METHODS:: We retrospectively identified 12 @entity1 who underwent stent implantation for sudden symptomatic occlusion of the proximal @entity6455 . In 8 @entity1 , no additional intracranial occlusions were identified. In 4 @entity1 , an additional intracerebral @entity715 was detected in the middle cerebral artery (MCA). Distal protection devices were used in all cases. We evaluated the presence and amount of retrieved @entity887 in the distal protection devices. The incidence and location of @entity12870 were determined using DWI. RESULTS:: Recanalization of the proximal @entity6455 was achieved in all @entity1 . After complete occlusion of the proximal @entity6455 was demonstrated, primary passage of the embolic protection device through the occluded @entity6455 was gently navigated in 7 @entity1 . However, this was not possible in 5 @entity1 . 3 @entity1 developed new lesions on post-procedural DWI. Of the 12 @entity1 in which distal protection devices were used, debris was detected in 7 @entity1 . CONCLUSION:: In endovascular revascularization of proximal @entity6455 occlusion, @entity12870 occur less frequently than reported in a systematic review of the DWI literature. The real risk of dislodging thrombi appears to be from plaque fragment mobilization by angioplasty, rather than crossing an occluded segment.
