Περίληψη:
Objectives: There is a paucity of knowledge in the literature relating to the extent of clot burden and stroke etiology. In this study, we measured the Extracted Clot Area (ECA) retrieved during endovascular treatment (EVT) and investigated relationships with suspected etiology, administration of intravenous thrombolysis and recanalization. Materials and Methods: As part of the multi-institutional RESTORE registry, the ECA retrieved during mechanical thrombectomy was quantified using ImageJ. The effect of stroke etiology (Large-artery atherosclerosis (LAA), Cardioembolism, Cryptogenic and other) and recombinant tissue plasminogen activator (rtPA) on ECA and recanalization outcome (mTICI) was assessed. Successful recanalization was described as mTICI 2c-3. Results: A total of 550 patients who underwent EVT with any clot retrieved were included in the study. The ECA was significantly larger in the LAA group compared to all other etiologies. The average ECA size of each etiology was; LAA=109 mm2, Cardioembolic=52 mm2, Cryptogenic=47 mm2 and Other=52 mm2 (p=0.014*). LAA patients also had a significantly poorer rate of successful recanalization (mTICI 2c-3) compared to all other etiologies (p=0.003*). The administration of tPA was associated with a smaller ECA in both LAA (p=0.007*) and cardioembolic (p=0.035*) groups. Conclusion: The ECA of LAA clots was double the size of all other etiologies and this is associated with a lower rate of successful recanalization in LAA stroke subtype. rtPA administration prior to thrombectomy was associated with reduced ECA in LAA and CE clots. © 2020 The Authors
Συγγραφείς:
Fitzgerald, S.
Rossi, R.
Mereuta, O.M.
Molina, S.
Okolo, A.
Douglas, A.
Jabrah, D.
Pandit, A.
McCarthy, R.
Gilvarry, M.
Ceder, E.
Dehlfors, N.
Dunker, D.
Nordanstig, A.
Redfors, P.
Jood, K.
Magoufis, G.
Psychogios, K.
Tsivgoulis, G.
Alderson, J.
O'Hare, A.
Power, S.
Brennan, P.
Nagy, A.
Vadász, Á.
Brinjikji, W.
Kallmes, D.
Szikora, I.
Tatlisumak, T.
Rentzos, A.
Thornton, J.
Doyle, K.M.
Λέξεις-κλειδιά:
alteplase, Article; blood vessel occlusion; brain atherosclerosis; cardioembolic stroke; cerebrovascular accident; clinical outcome; cohort analysis; comparative study; data analysis software; endovascular surgery; human; limit of quantitation; major clinical study; mechanical thrombectomy; neuropathology; patient selection; priority journal; recanalization; adverse event; atherosclerosis; brain circulation; brain ischemia; clinical trial; complication; diagnostic imaging; endovascular surgery; Europe; fibrinolytic therapy; multicenter study; pathophysiology; register; risk assessment; risk factor; thrombectomy; time factor; treatment outcome; vascular patency, Atherosclerosis; Cerebrovascular Circulation; Endovascular Procedures; Europe; Humans; Ischemic Stroke; Registries; Risk Assessment; Risk Factors; Thrombectomy; Thrombolytic Therapy; Time Factors; Treatment Outcome; Vascular Patency
