Background:The interaction between the stent retriever and clot is a key factor for recanalization during mechanical thrombectomy. Objective:To evaluate the association between radiographically apparent features during thrombectomy and angiographic outcomes using the Trevo ProVue, which has a fully radiopaque strut. Methods:We retrospectively reviewed 50 patients with acute middle cerebral artery occlusion who were treated with the Trevo. Patients were divided into groups that achieved (1 st -pass recanalization group, n=21) or did not achieve (non-1 st -pass recanalization group, n=29) a modified Thrombolysis in Cerebral Ischemia score of 2b or 3 with the 1 st -pass procedure.Patients were also divided into a thromboembolic (n=49) and atherosclerotic (n=11) group by occlusion etiology. We evaluated radiographic findings of the Trevo strut, e.g., degree of stent expansion and filling defect of the thrombus in the strut (in-stent thrombus sign) during the 1 st -pass procedure among these groups. Results:The median stent expansion was significantly greater in the 1 st -pass recanalization than non-1 st -pass recanalization group (60% versus 34%; P<0.01), and in the thromboembolic than atherosclerotic group (45% versus 31%; P<0.01). The receiver operator characteristic curve shows moderate capacity of the prediction for recanalization and etiology, with an area under the curve of 0.83 and 0.73, respectively. The in-stent thrombus sign was significantly more common in the thromboembolic than atherosclerotic groups (86% versus 10%; P<0.01). Conclusions:Greater stent expansion was associated with recanalization after thrombectomy. The in-stent thrombus sign may be useful for etiology prediction. These radiographic findings could provide useful real-time feedback during procedure, reflecting the clot−stent interaction.

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Langerhans cell histiocytosis (LCH) is characterised by tissue destruction caused by the abnormal proliferation of pathogenic dendritic cells. We report a rare case of multi-system LCH with local invasion of the orbital apex. A 56-year-old woman suffered from a decrease of visual acuity in the left eye caused by central scotoma and the limitation of eye movement in all directions. Magnetic resonance imaging revealed an enhanced lesion in the left orbital apex, suggesting optic nerve compression. She had been diagnosed with eosinophilic granuloma 24 years previously. Two weeks after the current presentation, we admitted the patient for optic canal and orbital apex decompression and subtotal tumour resection. Histopathological analysis confirmed the diagnosis of LCH. Post-surgical treatment with low-dose cytarabine was initiated for the residual tumour. However, it was ceased because of myelosuppression-induced pyelonephritis. After surgery, the central scotoma disappeared on day 5 and eye movement palsy resolved by 6 months. After the cessation of cytarabine, she has received low-dose steroid therapy for 2 years with no recurrence. Early surgical intervention with low-dose steroid therapy can lead to recovery of visual acuity and resolve eye movement palsy in patients with lesions of the orbital apex caused by multi-system LCH.