Predictive value of thrombus volume for recanalization in stent retriever thrombectomy

Baek, Jang Hyun; Yoo, Joonsang; Song, Dongbeom; Nam, Hyo Suk; Kim, Byung Moon; Kim, Dong Joon; Lee, Hye Sun; Heo, Ji Hoe

doi:10.1038/s41598-017-16274-9

Cited by 37 publications

(38 citation statements)

References 34 publications

(41 reference statements)

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“…Especially for patients with ICA occlusions mSAVE seems to be a promising approach as the rate of complete and successful reperfusion after a single pass was 46% and 73%, respectively. In a recent study from Baek et al, only 22% of ICA occlusions were successfully reperfused after one attempt and the rate of overall successful reperfusion (which both were graded as modified TICI) was lower compared to our results (76% vs. 82%) [16]; additionally, in 29% of the successfully reperfused patients four or more passes were necessary. In comparison to our recent results with SAVE, the first-pass and overall complete reperfusion rate is also higher in ICA occlusions (26% and 49%, respectively) [9].…”

Section: Discussioncontrasting

confidence: 87%

“…While in a post hoc analysis of the ASTER trial it was shown that successful reperfusion was less frequently achieved in patients with a low CBS, Treurniet et al found no evidence that CBS modifies the effect of intra-arterial treatment in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) cohort [5,21]. In our opinion, it is reasonable to assume that thrombus volume is an independent factor of successful reperfusion [16].…”

Section: Discussionmentioning

confidence: 99%

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Clot reduction prior to embolectomy: mSAVE as a first-line technique for large clots

Psychogios¹,

Tsogkas²,

Hesse³

et al. 2019

PLoS ONE

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Introduction The “Stent retriever Assisted Vacuum-locked Extraction” (SAVE) technique is a promising embolectomy method for intracranial large vessel occlusion (LVO). We report our experience using a modified SAVE (mSAVE) approach for clot reduction prior to embolectomy in acute ischemic stroke patients with large clots. Materials and methods We retrospectively analyzed 20 consecutive patients undergoing mSAVE in our center due to intracranial LVO. Angiographic data (including first-pass and overall complete reperfusion, defined as an expanded Thrombolysis in Cerebral Infarction (eTICI) score of 3, rate of successful reperfusion (eTICI ≥2c), number of passes, time from groin puncture to reperfusion) and clinical data (favorable outcome at 90 days, defined as modified Rankin Scale (mRS) ≤2) were assessed. Results First-pass and overall eTICI 3 reperfusion was reached in 13/20 (65%) and 14/20 (70%), respectively. The rate of successful reperfusion (eTICI ≥2c) after one pass was 85% and on final angiogram 90% with an average number of 1.1 ± 0.3 attempts. Eight out of 11 (73%) ICA occlusions were reperfused successfully and 5 (46%) completely after a single pass. Median groin to reperfusion time was 33 minutes (IQR 25–46). A favorable clinical outcome was achieved in 9/20 (45%) patients at discharge and after 90 days, respectively. Conclusion Clot reduction followed by embolectomy (mSAVE) is feasible and may be an important tool in the treatment of large clots.

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Section: Discussioncontrasting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Clot reduction prior to embolectomy: mSAVE as a first-line technique for large clots

Psychogios¹,

Tsogkas²,

Hesse³

et al. 2019

PLoS ONE

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“…Several possible causal relations between prolonged ATG intervals and reduced rates of TICI 2b-3 have previously been discussed, 5 such as thrombus modification over time (volume/extension, 17 histological features 18 ), which might influence mechanical reperfusion efficacy. 19 , 20 At first sight, however, this may be contradictive to the only small association between STA and TICI 2b-3 because STA does usually constitute by far more of the time interval elapsed between symptom onset and the start of the intervention (≈2/3 in our cohort). Bourcier et al argued that the effect of STA may be diluted by uncertainties regarding the exact time point of symptom onset.…”

Section: Discussionmentioning

confidence: 60%

Effect of Pre- and In-Hospital Delay on Reperfusion in Acute Ischemic Stroke Mechanical Thrombectomy

Kaesmacher

Maamari

Meinel

et al. 2020

Stroke

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Background and Purpose: Post hoc analyses of randomized controlled clinical trials evaluating mechanical thrombectomy have suggested that admission-to-groin-puncture (ATG) delays are associated with reduced reperfusion rates. Purpose of this analysis was to validate this association in a real-world cohort and to find associated factors and confounders for prolonged ATG intervals. Methods: Patients included into the BEYOND-SWIFT cohort (Bernese-European Registry for Ischemic Stroke Patients Treated Outside Current Guidelines With Neurothrombectomy Devices Using the Solitaire FR With the Intention for Thrombectomy; https://www.clinicaltrials.gov ; Unique identifier: NCT03496064) were analyzed (n=2386). Association between baseline characteristics and ATG was evaluated using mixed linear regression analysis. The effect of increasing symptom-onset-to-admission and ATG intervals on successful reperfusion (defined as Thrombolysis in Cerebral Infarction [TICI] 2b-3) was evaluated using logistic regression analysis adjusting for potential confounders. Results: Median ATG was 73 minutes. Prolonged ATG intervals were associated with the use of magnetic resonance imaging (+19.1 [95% CI, +9.1 to +29.1] minutes), general anesthesia (+12.1 [95% CI, +3.7 to +20.4] minutes), and borderline indication criteria, such as lower National Institutes of Health Stroke Scale, late presentations, or not meeting top-tier early time window eligibility criteria (+13.8 [95% CI, +6.1 to +21.6] minutes). There was a 13% relative odds reduction for TICI 2b-3 (adjusted odds ratio [aOR], 0.87 [95% CI, 0.79–0.96]) and TICI 2c/3 (aOR, 0.87 [95% CI, 0.79–0.95]) per hour ATG delay, while the reduction of TICI 2b-3 per hour increase symptom-onset-to-admission was minor (aOR, 0.97 [95% CI, 0.94–0.99]) and inconsistent regarding TICI 2c/3 (aOR, 0.99 [95% CI, 0.97–1.02]). After adjusting for identified factors associated with prolonged ATG intervals, the association of ATG delay and lower rates of TICI 2b-3 remained tangible (aOR, 0.87 [95% CI, 0.76–0.99]). Conclusions: There is a great potential to reduce ATG, and potential targets for improvement can be deduced from observational data. The association between in-hospital delay and reduced reperfusion rates is evident in real-world clinical data, underscoring the need to optimize in-hospital workflows. Given the only minor association between symptom-onset-to-admission intervals and reperfusion rates, the causal relationship of this association warrants further research. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03496064.

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“…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. 16,17 However, when considering the use of stent retrievers only (as opposed to aspiration thrombectomy), Mokin et al reported in their series a positive association between higher-density clots on NCCT and rate of SR using the Solitaire (eV3, Irvine, CA, USA) stent retriever. 4 Thrombus perviousness has recently been described as a method of estimating how permeable a clot is using enhancement and washout measures using arterialand delayed-phase CTA.…”

Section: Discussionmentioning

confidence: 99%

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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Predictive value of thrombus volume for recanalization in stent retriever thrombectomy

Cited by 37 publications

References 34 publications

Clot reduction prior to embolectomy: mSAVE as a first-line technique for large clots

Clot reduction prior to embolectomy: mSAVE as a first-line technique for large clots

Effect of Pre- and In-Hospital Delay on Reperfusion in Acute Ischemic Stroke Mechanical Thrombectomy

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

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