Large Artery Atherosclerotic Clots are Larger than Clots of other Stroke Etiologies and have Poorer Recanalization rates

Seán Fitzgerald, Rosanna Rossi, Oana Madalina Mereuta, Sara Molina, Adaobi Okolo, Andrew Douglas, Duaa Jabrah, Abhay Pandit, Ray McCarthy, Michael Gilvarry, Erik Ceder, Niclas Dehlfors, Dennis Dunker, Annika Nordanstig, Petra Redfors, Katarina Jood, Georgios Magoufis, Klearchos Psychogios, Georgios Tsivgoulis, Jack AldersonAlan O'Hare, Sarah Power, Paul Brennan, András Nagy, Ágnes Vadász, Waleed Brinjikji, David Kallmes, Istvan Szikora, Turgut Tatlisumak, Alexandros Rentzos, John Thornton, Karen M. Doyle

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Article number105463
JournalJournal of Stroke and Cerebrovascular Diseases
Issue number1
StatePublished - Jan 2021


  • Acute ischemic stroke
  • Etiology
  • Thrombectomy
  • Thrombolysis

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine


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