Association of clot burden score with radiographic and clinical outcomes following Solitaire stent retriever thrombectomy: analysis of the SWIFT PRIME trial

Mokin, Maxim; Levy, Elad I.; Siddiqui, Adnan H.; Goyal, Mayank; Nogueira, Raul G; Yavagal, Dileep R.; Pereira, Vítor Mendes; Saver, Jeffrey L.

doi:10.1136/neurintsurg-2016-012631

Cited by 19 publications

(9 citation statements)

References 17 publications

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“…Additionally, clots with a higher proportion of fibrin demonstrate more pronounced contrast uptake than those rich in red blood cells after prolonged exposure; however, they could not be differentiated after initial contrast exposure. 13 The correlation between thrombus density on NCCT and SR using IVT, intraarterial thrombolysis and mechanical thrombectomy has been reported, 5,14,15 and a recent systematic review concluded that the hyperdense artery sign on NCCT is associated with red blood cell-rich thrombus and better successful recanalization rates. 6 Other studies have failed to confirm these findings, however, and overall the literature has been conflicting with some studies showing no association between clot density and recanalization with stent retrievers or aspiration.…”

Section: Discussionmentioning

confidence: 98%

Thrombus perviousness is not associated with first-pass revascularization using stent retrievers

et al. 2019

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Background and purpose Recent studies suggest that thrombus imaging characteristics such as Hounsfield unit (HU) and perviousness assessed on noncontrast computed tomography (NCCT) and CT angiography (CTA) can predict successful recanalization. We assessed whether these thrombus imaging characteristics could predict successful first-pass recanalization. Methods We retrospectively reviewed cases of mechanical thrombectomy over a three-year period in which patients received a multiphase CTA and were treated with a stent retriever on first pass. Thrombus attenuation, thrombus enhancement on arterial- and delayed-phase CTA and percentage washout were calculated and their association with first-pass recanalization, successful recanalization and distal embolic complications was studied. Results Fifty-two mechanical thrombectomy patients were included. First-pass recanalization was achieved in 59.6% and complete revascularization (Thrombolysis in Cerebral Infarction scale 2b/3) was achieved in 84.6%. There was no correlation between first-pass recanalization with thrombus density on NCCT ( p = 0.94), percentage enhancement on arterial ( p = 0.61) and delayed-phase CTA ( p = 0.23) or thrombus length ( p = 0.16). There was no correlation between number of passes and either thrombus density on NCCT ( p = 0.91) or percentage enhancement on arterial- ( p = 0.79) and delayed-phase ( p = 0.14) CTA or thrombus length ( p = 0.34). Clot length was significantly higher in patients with distal embolic complications than in those without (18.5 ± 7.9 vs 11.4 ± 6.6 mm, p = 0.005). Conclusions Our data suggest that thrombus imaging characteristics on multiphase CTA cannot predict first-pass recanalization or successful revascularization in acute ischemic stroke patients treated with stent retrievers. Longer clot length was associated with higher risk of distal embolic complications.

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Section: Discussionmentioning

confidence: 98%

Thrombus perviousness is not associated with first-pass revascularization using stent retrievers

et al. 2019

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“…Although thrombus length is strongly associated with successful recanalization with intravenous tPA therapy, the predictive power of thrombus size in determining successful reperfusion in EVT appears to be diminished (14). The results of recent RCTs showed that there was no correlation between the clot burden score (using clot volume and length) and the effects of EVT (72, 73). Thrombus composition and its associated pathogenesis can be visualized by CT or MRI.…”

Section: Specific Diagnostic and Therapeutic Considerations In Evt Fomentioning

confidence: 99%

Endovascular Therapy for Acute Ischemic Stroke of Intracranial Atherosclerotic Origin—Neuroimaging Perspectives

et al. 2019

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Large vessel occlusion (LVO) due to intracranial atherosclerosis (ICAS) is a common cause of acute ischemic stroke (AIS) in Asians. Endovascular therapy (EVT) has been established as the mainstay of treatment in patients with AIS and LVO. However, only a few patients of Asian descent with ICAS-related LVO (ICAS-LVO) were included in recent randomized controlled trials of EVT for AIS. Therefore, the findings of these trials cannot be directly applied to Asian patients with ICAS-LVO. In embolic LVO due to thrombus from the heart or a more proximal vessel, rapid, and complete recanalization can be achieved in more than 70–80% of patients, and it is important to exclude patients with large cores. In contrast, patients with ICAS-LVO usually have favorable hemodynamic profiles (good collateral status, small core, and less severe perfusion deficit), but poor response to EVT (more rescue treatments and longer procedure times are required for successful recanalization due to higher rates of reocclusion). Patients with ICAS-LVO may have different anatomic (plaque, angioarchitecture), hemodynamic (collateral status), and pathophysiologic (thrombus composition) features on neuroimaging compared to patients with embolic LVO. In this review, we discuss these neuroimaging features, their clinical implications with respect to determination of EVT responses, and the need for development of specific EVT devices and procedures for patients with ICAS-LVO.

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“…The results of the studies were inconsistent ( Table 2 ). It might be because of the different mechanical devices used, different methods used to determine thrombus size, and small number of cases included [ 21 , 25 - 30 ]. However, in a recent study of a relatively large number of patients who were treated with a stent retriever, higher clot burden scores were associated with increased likelihood of recanalization [ 2 ].…”

Section: Prediction Of Recanalization Based On Thrombus Sizementioning

confidence: 99%

Computed Tomography-Based Thrombus Imaging for the Prediction of Recanalization after Reperfusion Therapy in Stroke

et al. 2017

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The prediction of successful recanalization following thrombolytic or endovascular treatment may be helpful to determine the strategy of recanalization treatment in acute stroke. Thrombus can be detected using noncontrast computed tomography (CT) as a hyperdense artery sign or blooming artifact on a T2*-weighted gradient-recalled image. The detection of thrombus using CT depends on slice thickness. Thrombus burden can be determined in terms of the length, volume, and clot burden score. The thrombus size can be quantitatively measured on thin-section CT or CT angiography/magnetic resonance angiography. The determination of thrombus size may be predictive of successful recanalization/non-recanalization after intravenous thrombolysis and endovascular treatment. However, cut-offs of thrombus size for predicting recanalization/non-recanalization are different among studies, due to different methods of measurements. Thus, a standardized method to measure the thrombus is necessary for thrombus imaging to be useful and reliable in clinical practice. Software-based measurements may provide a reliable and accurate assessment. The measurement should be easy and rapid to be more widely used in practice, which could be achieved by improvement of the user interface. In addition to prediction of recanalization, sequential measurements of thrombus volume before and after the treatment may also be useful to determine the efficacy of new thrombolytic drugs. This manuscript reviews the diagnosis of thrombus, prediction of recanalization using thrombus imaging, and practical considerations for the measurement of thrombus burden and density on CT.

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Association of clot burden score with radiographic and clinical outcomes following Solitaire stent retriever thrombectomy: analysis of the SWIFT PRIME trial

Abstract: The combination of IV thrombolysis and stent retriever thrombectomy with the Solitaire device is highly effective in achieving successful recanalization and a good clinical outcome throughout the entire range of CBS values.

Cited by 19 publications

References 17 publications

Thrombus perviousness is not associated with first-pass revascularization using stent retrievers

Thrombus perviousness is not associated with first-pass revascularization using stent retrievers

Endovascular Therapy for Acute Ischemic Stroke of Intracranial Atherosclerotic Origin—Neuroimaging Perspectives

Computed Tomography-Based Thrombus Imaging for the Prediction of Recanalization after Reperfusion Therapy in Stroke

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