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Quantitative analysis of thrombus migration before mechanical thrombectomy: Determinants and relationship with procedural and clinical outcomes - 10/12/21

Doi : 10.1016/j.neurad.2021.11.005 
Clara Cohen a, e, , Kathleen Gaillot a, Héloïse Ifergan a, b, e, Maëlle Dejobert a, Marie Gaudron c, Elisabeth Molinier c, Aymeric Amelot d, Jean-Philippe Cottier a, Richard Bibi b, Kévin Janot b, e, Christophe Magni e, Ana-Paula Narata f, Grégoire Boulouis b
a University Hospital of Tours, Department of Diagnostic Neuroradiology, Tours, France 
b University Hospital of Tours, Department of Interventional Neuroradiology, Tours, France 
c University Hospital of Tours, Department of Neurology, Tours, France 
d University Hospital of Tours, Department of Neurosurgery, Tours, France 
e Regional Hospital of Orleans, Department of Neuroradiology, Orléans, France 
f University Hospital of Southampton, Department of Interventional Neuroradiology, United Kingdom 

Corresponding author at: University Hospital of Tours, Diagnostical Neuroradiology Department, 2 boulevard Tonnellé, 37000 Tours, France.University Hospital of ToursDiagnostical Neuroradiology Department, 2 boulevard TonnelléTours37000France
En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Friday 10 December 2021

Abstract

Background and purpose

In patients with acute ischemic stroke (AIS) and a large vessel occlusion (LVO), thrombus migration (T-Mig) is a common phenomenon before mechanical thrombectomy (MT), revealed by pre-treatment imaging. Previous works have used qualitative scales to define T-Mig. The aim of this study was to evaluate the determinants and impact of quantitatively assessed T-Mig on procedural characteristics and clinical outcome.

Methods

Consecutive patients with AIS due to LVO treated by MT at a reference academic hospital were analysed. Distance between vessel origin and beginning of the thrombus on MRI (3D-time-of-flight and/or contrast-enhanced magnetic-resonance-angiography) and digital-substracted-angiography (DSA) were measured in millimeters using a curve tool. Thrombus migration was defined quantitatively as ∆TD calculated as the difference between pre-MT-DSA and MRI thrombus location. ∆TD was rated as significant if above 5mm.

Results

A total of 267 patients were included (mean age 70±12 years; 46% females) were analyzed. Amongst them, 65 (24.3%) experienced any degree of T-Mig. T-Mig was found to be associated with iv-tPA administration prior to thrombectomy (β-estimate 2.52; 95% CI [1.25–3.79]; p<0.001), fewer device passes during thrombectomy (1.22±1.31 vs 1.66±0.99; p<0.05), and shorter pre-treatment thrombi (β-estimate -0.1millimeter; 95% CI [-0.27–0.07]; p<0.05). There was no association between T-Mig and a favourable outcome (defined by a 0-to-2 modified-Rankin-Scale at 3months, adjusted OR: 2.16 [0.93 – 5.02]; p=0.06)

Conclusion

Thrombus migration happens in almost a fourth of our study sample, and its quantitative extent was associated with iv-tPA administration prior to MT, but not with clinical outcome.

El texto completo de este artículo está disponible en PDF.

Graphical abstract




Image, graphical abstract

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Highlight

In patient with acute ischemic stroke due to large vessel occlusion, thrombus migration occuring between baseline imaging and mechanical thrombectomy is a recognized phenomenon, with poorly understood consequences on procedural and clinical outcome.
In a cohort of 267 consecutive patients we quantitatively assessed thrombus migration by measuring the distance difference of thrombus proximal tip between baseline MRI and the first angiographic run of the thrombectomy.
Thrombus migration > 5mm occurred in 24.3% of the study sample, and was associated with tPA administration and shorter thrombus length.
Thrombus migration was not positively or negatively associated with clinical outcome in our sample.

El texto completo de este artículo está disponible en PDF.

Keywords : Ischemic stroke, Migration, Thrombus, Mechanical thrombectomy, Thrombolysis, Subject terms: ischemic stroke, Imaging, revascularization


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