Importance of truncal-type occlusion in stentriever-based thrombectomy for acute stroke

Baek, Jang Hyun; Kim, Byung Moon; Kim, Dong Joon; Heo, Ji Hoe; Nam, Hyo Suk; Song, Dongbeom; Bang, Oh Young

doi:10.1212/wnl.0000000000003202

Cited by 100 publications

(139 citation statements)

References 36 publications

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“…Moreover, as the BA system has abundant collateral system including the retrograde flow from posterior communicating arteries, clot growth due to the obstruction‐related blood stasis might dominantly develop to caudal directions 9. Therefore, the location of the distal portion of clot sign might more properly represent the primary occlusion site than the proximal portion of clot, which explains how the presence of clot signs in the distal BA segment well correlates with an embolism mechanism 6, 11…”

Section: Discussionmentioning

confidence: 99%

“…The source of embolism included a cardiac source with high primary risk for ischemic stroke, listed in the SSS‐TOAST classification algorithm,12 a ≥ 50% stenosis or a fresh thrombus on atherosclerotic plaque in proximal arteries, a dissection in vertebral arteries,6, 11, 12 and a systemic coagulopathy associated with cancer or rheumatic disease. To establish the source of embolism, we investigated continuous electrocardiography monitoring during the acute stroke phase, transthoracic echocardiography (TTE), and, if available, 24‐h heart‐rate monitoring, aortic CT angiography, or transesophageal echocardiography (TEE) performed in‐hospital or during follow‐up after discharge 12.…”

Section: Methodsmentioning

confidence: 99%

“…Considering the distinct hemodynamic characteristic of BA compared to the anterior‐circulation arteries,9 the site of occlusion in BA segment may have a strong association with the underlying stroke mechanism and outcomes after EVT 11…”

Section: Introductionmentioning

confidence: 99%

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Impact of stroke mechanism in acute basilar occlusion with reperfusion therapy

Lee

Jung

Ryu

et al. 2018

Ann Clin Transl Neurol

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ObjectiveWe aimed to evaluate the impact of underlying mechanism of basilar artery (BA) occlusion on the outcomes after endovascular therapy (EVT) for reperfusion and the outcome factors associated with each mechanism, and to identify radiologic parameters enabling to distinguish the underlying mechanism.MethodsFrom a registry database, 194 consecutive patients with acute BA occlusion who underwent EVT were analyzed. Stroke mechanism, classified into in situ atherosclerotic thrombosis (ISAT) and embolism, clot sign location profiles in pre‐angiography magnetic resonance image (MRI), parameters of angiography and EVT, and reperfusion were assessed. Poor outcome was defined as a modified Rankin‐Scale score at 90 days of 3–6.ResultsThe mean age was 68.8±11.8 years (range 21–92 years) and seventy‐eight (40.2%) were female patients. 102 (52.6%) patients were classified into an embolism mechanism and 92 (47.4%) into an ISAT mechanism. Overall, ISAT mechanism compared with embolism was significantly associated with poor outcomes (P = 0.002), along with the NIHSS scores, reperfusion status, and collateral status. In the embolism group, reperfusion (P = 0.001), NIHSS scores (P < 0.001), and onset‐to‐treatment time (P = 0.030) were significant outcome factors. However, in the ISAT group, baseline collateral status (P = 0.001) and NIHSS scores (P < 0.001) were significant outcome factors. A clot sign at the distal BA segment on pre‐angiography MRI was strongly associated with embolism mechanism (P < 0.001).InterpretationStroke mechanism has a major influence on outcomes, and outcome predictors differ according to the underlying mechanism in acute BA occlusion with EVT. Clot sign profile on pre‐angiography MRI might be useful to determine the underlying mechanism.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Impact of stroke mechanism in acute basilar occlusion with reperfusion therapy

Lee

Jung

Ryu

et al. 2018

Ann Clin Transl Neurol

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“…3 Recently, the success of endovascular therapy has been reported to be affected by the sources of the vessel occlusion. 4 Cardioembolism (CE) and large-artery atherosclerosis (LAA) are the 2 common causes of LAO. However, differentiating these 2 etiologies is often challenging, especially in an acute clinical scenario where a quick treatment decision must be made after acute ischemic stroke.…”

mentioning

confidence: 99%

“…6,7 Another study showed that the branching-site occlusion on digital subtraction angiography was highly associated with CE. 4 Because CT is available in most emergency departments of comprehensive stroke centers, perfusion CT is routinely performed before reperfusion treatment. Given that DSA is an invasive procedure and MR imaging has its contraindications, dynamic CT angiography derived from CTP is a more ideal and convenient technique, which can provide dynamic angiographic and parenchymal information.…”

mentioning

confidence: 99%

Prediction of the Multisegment Clot Sign on Dynamic CT Angiography of Cardioembolic Stroke

Chen

Shi

Zhang

et al. 2018

AJNR Am J Neuroradiol

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Characterization of clot composition in acute cerebral infarct using machine learning techniques

Chung

Kim

Cha

et al. 2019

Ann Clin Transl Neurol

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Objective Clot characteristics can provide information on the cause of cerebral artery occlusion and may guide acute revascularization and secondary prevention strategies. We developed a rapid automated clot analysis system using machine learning ( ML ) and validated its accuracy in patients undergoing endovascular treatment. Methods Pre‐endovascular treatment gradient echo ( GRE ) images from consecutive patients with middle cerebral artery occlusion were utilized to develop and validate an ML system to predict whether atrial fibrillation ( AF ) was the underlying cause of ischemic stroke. The accuracy of the ML algorithm was compared with that of visual inspection by neuroimaging specialists for the presence of blooming artifact. Endovascular procedures and outcomes were compared in patients with and without AF . Results Of 67 patients, 29 (43.3%) had AF . Of these, 13 had known AF and 16 were newly diagnosed with cardiac monitoring. By visual inspection, interrater correlation for blooming artifact was 0.73 and sensitivity and specificity for AF were 0.79 and 0.63, respectively. For AF classification, the ML algorithms yielded an average accuracy of > 75.4% in fivefold cross‐validation with clot signal profiles obtained from 52 patients and an area under the curve >0.87 for the average AF probability from five signal profiles in external validation ( n = 15). Analysis with an in‐house interface took approximately 3 min per patient. Absence of AF was associated with increased number of passes by stentriever, high reocclusion frequency, and additional use of rescue stenting and/or glycogen II b/ III a blocker for recanalization. Interpretation ML ‐based rapid clot analysis is feasible and can identify AF with high accuracy, enabling selection of endovascular treatment strategy.

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Importance of truncal-type occlusion in stentriever-based thrombectomy for acute stroke

Abstract: Angiographic occlusion type is an independent predictor of stentriever refractoriness and of the underlying stroke mechanism.

Cited by 100 publications

References 36 publications

Impact of stroke mechanism in acute basilar occlusion with reperfusion therapy

Impact of stroke mechanism in acute basilar occlusion with reperfusion therapy

Prediction of the Multisegment Clot Sign on Dynamic CT Angiography of Cardioembolic Stroke

Characterization of clot composition in acute cerebral infarct using machine learning techniques

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