TY - JOUR
T1 - Thrombus Imaging Characteristics and Outcomes in Acute Ischemic Stroke Patients Undergoing Endovascular Treatment
AU - Dutra, Bruna G.
AU - Tolhuisen, Manon L.
AU - Alves, Heitor C. B. R.
AU - Treurniet, Kilian M.
AU - Kappelhof, Manon
AU - Yoo, Albert J.
AU - Jansen, Ivo G. H.
AU - Dippel, Diederik W. J.
AU - van Zwam, Wim H.
AU - van Oostenbrugge, Robert J.
AU - da Rocha, Antonio J.
AU - Lingsma, Hester F.
AU - van der Lugt, Aad
AU - Roos, Yvo B. W. E. M.
AU - Marquering, Henk A.
AU - Majoie, Charles B. L. M.
AU - MR CLEAN Registry Investigators
N1 - Funding Information:
Received November 14, 2018; final revision received March 6, 2019; accepted April 1, 2019. From the Departments of Radiology and Nuclear Medicine (B.G.D., H.C.B.R.A., K.M.T., M.K., I.G.H.J., C.B.L.M.M.), Biomedical Engineering and Physics (B.G.D., M.L.T., H.C.B.R.A., H.A.M.), and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Departments of Radiology (A.v.d.L.), Neurology (D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); Departments of Radiology (W.H.v.Z) and Neurology (R.J.v.O.), and Cardiovascular Research Institute Maastricht (W.H.v.Z., R.J.v.O.), Maastricht University Medical Center, the Netherlands; and Department of Radiology, Irmandade Santa Casa de Misericórdia de São Paulo, Brazil (B.G.D., H.C.B.R.A., A.J.d.R.). *Dr Dutra and M.L. Tolhuisen contributed equally. †A list of all MR CLEAN Registry Investigators is given in the online-only Data Supplement. Guest Editor for this article was Sean I. Savitz, MD. The online-only Data Supplement is available with this article at https://www.ahajournals.org/doi/suppl/10.1161/STROKEAHA.118.024247. Correspondence to Bruna G. Dutra, MD, Department of Radiology and Nuclear Medicine and Department of Biomedical Engineering and Physics, Academic Medical Center, P.O. Box 22660, Amsterdam 1100DD, the Netherlands. Email [email protected] © 2019 American Heart Association, Inc.
Funding Information:
Erasmus University Medical Center received funds from Stryker, Medtronic, Penumbra, Siemens for consultations by Drs van der Lugt and Dippel. Academic Medical Center Amsterdam received funds from Stryker for consultations by Drs Majoie and Roos. Maastricht University Medical Center received funds from Stryker and Codman for consultations by Dr van Zwam. Dr Majoie also reports research grants from the TWIN Foundation, the Netherlands Cardiovascular Research Committee (CVON)/Dutch Heart Foundation, the European Commission, and Stryker. Dr Dippel also reports research grants from Dutch Heart Foundation, Brain Foundation Netherlands, the Netherlands Organisation for Health Research and Development, and Health Holland Top Sector Life Sciences & Health, and unrestricted grants from AngioCare BV, Medtronic, Covidien/EV3, Medac Gmbh/LAMEPRO, Penumbra Inc, Stryker, Top Medical/Concentric, Thrombolytic Science LLC, and Stryker European Operations BV. Dr Marquering is cofounder and shareholder of Nico-lab. Drs Jansen, Roos, and Majoie own stock in Nico-lab. Dr Yoo is a shareholder of Insera Therapeutics, received research grants from Medtronic, Cerenovus, Penumbra, Stryker, and Genentech, and received funds from Cerenovus and Genetech for consultations. The other authors report no conflicts.
Funding Information:
The MR CLEAN registry (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke) was partly funded by Stichting Toegepast Wetenschappelijk Instituut voor Neuromodulatie (TWIN) Foundation, Erasmus MC University Medical Center, Maastricht University Medical Center, and Academic Medical Center, Amsterdam.
Funding Information:
A1/A2 indicates occlusions in segment A1 or A2 of the anterior cerebral artery; ASPECTS, Alberta Stroke Program Early CT Score; DBP, diastolic blood pressure; DSA, digital subtraction angiography; DT, distance from the internal carotid artery terminus to the thrombus; EVT, endovascular treatment; HU, Hounsfield units; ICA, internal carotid artery; IQR, interquartile range; M1, segment M1 of the middle cerebral artery; M2, segment M2 of the middle cerebral artery; M3, segment M3 of the middle cerebral artery; MR CLEAN, Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands; NA, not available; NIHSS, National Institutes of Health Stroke Scale; and SBP, systolic blood pressure.
Publisher Copyright:
© 2019 American Heart Association, Inc.
PY - 2019/8
Y1 - 2019/8
N2 - Background and Purpose- Thrombus imaging characteristics have been reported to be useful to predict functional outcome and reperfusion in acute ischemic stroke. However, conflicting data about this subject exist in patients undergoing endovascular treatment. Therefore, we aimed to evaluate whether thrombus imaging characteristics assessed on computed tomography are associated with outcomes in patients with acute ischemic stroke treated by endovascular treatment.Methods- The MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry is an ongoing, prospective, and observational study in all centers performing endovascular treatment in the Netherlands. We evaluated associations of thrombus imaging characteristics with the functional outcome (modified Rankin Scale at 90 days), mortality, reperfusion, duration of endovascular treatment, and symptomatic intracranial hemorrhage using univariable and multivariable regression models. Thrombus characteristics included location, clot burden score (CBS), length, relative and absolute attenuation, perviousness, and distance from the internal carotid artery terminus to the thrombus. All characteristics were assessed on thin-slice (Results- In total, 408 patients were analyzed. Thrombus with distal location, higher CBS, and shorter length were associated with better functional outcome (adjusted common odds ratio, 3.3; 95% CI, 2.0-5.3 for distal M1 occlusion compared with internal carotid artery occlusion; adjusted common odds ratio, 1.15; 95% CI, 1.07-1.24 per CBS point; and adjusted common odds ratio, 0.96; 95% CI, 0.94-0.99 per mm, respectively) and reduced duration of endovascular procedure (adjusted coefficient B, -14.7; 95% CI, -24.2 to -5.1 for distal M1 occlusion compared with internal carotid artery occlusion; adjusted coefficient B, -8.5; 95% CI, -14.5 to -2.4 per CBS point; and adjusted coefficient B, 7.3; 95% CI, 2.9-11.8 per mm, respectively). Thrombus perviousness was associated with better functional outcome (adjusted common odds ratio, 1.01; 95% CI, 1.00-1.02 per Hounsfield units increase). Distal thrombi were associated with successful reperfusion (adjusted odds ratio, 2.6; 95% CI, 1.4-4.9 for proximal M1 occlusion compared with internal carotid artery occlusion).Conclusions- Distal location, higher CBS, and shorter length are associated with better functional outcome and faster endovascular procedure. Distal thrombus is strongly associated with successful reperfusion, and a pervious thrombus is associated with better functional outcome.
AB - Background and Purpose- Thrombus imaging characteristics have been reported to be useful to predict functional outcome and reperfusion in acute ischemic stroke. However, conflicting data about this subject exist in patients undergoing endovascular treatment. Therefore, we aimed to evaluate whether thrombus imaging characteristics assessed on computed tomography are associated with outcomes in patients with acute ischemic stroke treated by endovascular treatment.Methods- The MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry is an ongoing, prospective, and observational study in all centers performing endovascular treatment in the Netherlands. We evaluated associations of thrombus imaging characteristics with the functional outcome (modified Rankin Scale at 90 days), mortality, reperfusion, duration of endovascular treatment, and symptomatic intracranial hemorrhage using univariable and multivariable regression models. Thrombus characteristics included location, clot burden score (CBS), length, relative and absolute attenuation, perviousness, and distance from the internal carotid artery terminus to the thrombus. All characteristics were assessed on thin-slice (Results- In total, 408 patients were analyzed. Thrombus with distal location, higher CBS, and shorter length were associated with better functional outcome (adjusted common odds ratio, 3.3; 95% CI, 2.0-5.3 for distal M1 occlusion compared with internal carotid artery occlusion; adjusted common odds ratio, 1.15; 95% CI, 1.07-1.24 per CBS point; and adjusted common odds ratio, 0.96; 95% CI, 0.94-0.99 per mm, respectively) and reduced duration of endovascular procedure (adjusted coefficient B, -14.7; 95% CI, -24.2 to -5.1 for distal M1 occlusion compared with internal carotid artery occlusion; adjusted coefficient B, -8.5; 95% CI, -14.5 to -2.4 per CBS point; and adjusted coefficient B, 7.3; 95% CI, 2.9-11.8 per mm, respectively). Thrombus perviousness was associated with better functional outcome (adjusted common odds ratio, 1.01; 95% CI, 1.00-1.02 per Hounsfield units increase). Distal thrombi were associated with successful reperfusion (adjusted odds ratio, 2.6; 95% CI, 1.4-4.9 for proximal M1 occlusion compared with internal carotid artery occlusion).Conclusions- Distal location, higher CBS, and shorter length are associated with better functional outcome and faster endovascular procedure. Distal thrombus is strongly associated with successful reperfusion, and a pervious thrombus is associated with better functional outcome.
KW - computed tomography angiography
KW - endovascular procedure
KW - reperfusion
KW - stroke
KW - thrombectomy
KW - thrombus
KW - PREDICTS SUCCESSFUL RECANALIZATION
KW - CLOT BURDEN SCORE
KW - INTRAVENOUS THROMBOLYSIS
KW - MECHANICAL THROMBECTOMY
KW - INTRAARTERIAL TREATMENT
KW - CT ANGIOGRAPHY
KW - LENGTH
KW - OCCLUSION
KW - IMPACT
KW - THERAPY
U2 - 10.1161/STROKEAHA.118.024247
DO - 10.1161/STROKEAHA.118.024247
M3 - Article
C2 - 31216961
SN - 0039-2499
VL - 50
SP - 2057
EP - 2064
JO - Stroke
JF - Stroke
IS - 8
ER -