PT  - JOURNAL ARTICLE
AU  - M. Ribo
AU  - M. Rubiera
AU  - J. Pagola
AU  - D. Rodriguez-Luna
AU  - P. Meler
AU  - A. Flores
AU  - J. Alvarez-Sabin
AU  - C.A. Molina
TI  - Bringing Forward Reperfusion with Oxygenated Blood Perfusion beyond Arterial Occlusion during Endovascular Procedures in Patients with Acute Ischemic Stroke
AID  - 10.3174/ajnr.A2221
DP  - 2010 Nov 01
TA  - American Journal of Neuroradiology
PG  - 1899--1902
VI  - 31
IP  - 10
4099  - http://www.ajnr.org/content/31/10/1899.short
4100  - http://www.ajnr.org/content/31/10/1899.full
SO  - Am. J. Neuroradiol.2010 Nov 01; 31
AB  - BACKGROUND AND PURPOSE: High recanalization rates achieved with endovascular procedures are not always followed by the expected clinical improvement. These time-consuming procedures imply a delayed reperfusion despite the capacity of earlier intravascular microcatheter bypass to the ischemic tissue beyond the clot. We aimed to explore the safety and feasibility of MOB beyond the clot. MATERIALS AND METHODS: We studied patients with stroke undergoing endovascular procedures. The timing of procedural steps was recorded. We then explored the safety and feasibility of repeated femoral artery MOB injections beyond the occlusion every time the clot was crossed in 17 patients. Pre- and postocclusion flow was continuously monitored with TCD. RESULTS: We studied 60 patients (mean age, 70 ± 11 years; median NIHSS score, 20; IR, 18–21). Of them, 33 (55%) received IV-tPA before the endovascular procedure. The following arteries were occluded: the MCA (63.3%, n = 38) and the ICA (36.6%, n = 22). The TSO to arterial puncture was 193 ± 77 minutes. The occluding clot was successfully crossed with the microcatheter in 46 patients (76.6%; mean TSO, 228 ± 82 minutes). Recanalization was achieved in 44 patients (73.2%; mean TSO, 328 ± 144 minutes). Repeated MOB injections were performed in 17 patients. Patients with/without MOB presented with similar baseline characteristics. The median number of MOB injections was 2 (IR, 2–3), and the median injected blood volume was 40 mL (IR, 27.5–50). The mean time from first MOB to arterial recanalization was 136 ± 86 minutes. During MOB, a nonpulsatile flow appeared in previously nonvisible distal branches on TCD. CONCLUSIONS: In this small series, oxygenated blood delivered through a microcatheter positioned distal to the site of occlusion was feasible and safe. Until final recanalization is achieved, MOB injections may generate intermittent reperfusion for up to 2 hours. IAintra-arterialICAinternal carotid arteryIRinterquartile rangeIVintravenousMCAmiddle cerebral arteryMOBmicrocatheter oxygenated blood infusionmRSmodified Rankin ScaleNIHSSNational Institutes of Health Stroke ScaleTCDtranscranial Doppler sonographyTIMIThrombolysis in Myocardial InfarctiontPAtissue plasminogen activatorTSOtime from symptom onset