TY - JOUR
T1 - Large Artery Atherosclerotic Clots are Larger than Clots of other Stroke Etiologies and have Poorer Recanalization rates
AU - Fitzgerald, Seán
AU - Rossi, Rosanna
AU - Mereuta, Oana Madalina
AU - Molina, Sara
AU - Okolo, Adaobi
AU - Douglas, Andrew
AU - Jabrah, Duaa
AU - Pandit, Abhay
AU - McCarthy, Ray
AU - Gilvarry, Michael
AU - Ceder, Erik
AU - Dehlfors, Niclas
AU - Dunker, Dennis
AU - Nordanstig, Annika
AU - Redfors, Petra
AU - Jood, Katarina
AU - Magoufis, Georgios
AU - Psychogios, Klearchos
AU - Tsivgoulis, Georgios
AU - Alderson, Jack
AU - O'Hare, Alan
AU - Power, Sarah
AU - Brennan, Paul
AU - Nagy, András
AU - Vadász, Ágnes
AU - Brinjikji, Waleed
AU - Kallmes, David
AU - Szikora, Istvan
AU - Tatlisumak, Turgut
AU - Rentzos, Alexandros
AU - Thornton, John
AU - Doyle, Karen M.
N1 - Funding Information:
This work was supported by the European Regional Development Fund and Science Foundation Ireland grant number ( 13/RC/2073 ). R01 funding to the Brinjikji lab is also acknowledged ( 1R01NS105853 ).
Funding Information:
Dr. Karen Doyle received Research Funding support from Science Foundation Ireland that is co-funded by Cerenovus. All other authors declare no competing interests in relation to work described.
Publisher Copyright:
© 2020 The Authors
PY - 2021/1
Y1 - 2021/1
N2 - 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.
AB - 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.
KW - Acute ischemic stroke
KW - Etiology
KW - Thrombectomy
KW - Thrombolysis
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U2 - 10.1016/j.jstrokecerebrovasdis.2020.105463
DO - 10.1016/j.jstrokecerebrovasdis.2020.105463
M3 - Article
C2 - 33242780
AN - SCOPUS:85096644485
SN - 1052-3057
VL - 30
JO - Journal of Stroke and Cerebrovascular Diseases
JF - Journal of Stroke and Cerebrovascular Diseases
IS - 1
M1 - 105463
ER -