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

Szczegóły
Abstrakt

Tytuł:: Large Artery Atherosclerotic Clots are Larger than Clots of other Stroke Etiologies and have Poorer Recanalization rates.
Autorzy:: Fitzgerald S; Department of Physiology, National University of Ireland Galway, Galway, Ireland. Electronic address: .
Rossi R; Department of Physiology, National University of Ireland Galway, Galway, Ireland; CÚRAM-SFI Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland.
Mereuta OM; Department of Physiology, National University of Ireland Galway, Galway, Ireland; CÚRAM-SFI Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland.
Molina S; Department of Physiology, National University of Ireland Galway, Galway, Ireland; CÚRAM-SFI Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland.
Okolo A; Department of Physiology, National University of Ireland Galway, Galway, Ireland.
Douglas A; Department of Physiology, National University of Ireland Galway, Galway, Ireland; CÚRAM-SFI Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland.
Jabrah D; Department of Physiology, National University of Ireland Galway, Galway, Ireland.
Pandit A; CÚRAM-SFI Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland.
McCarthy R; Cerenovus, Galway Neuro Technology Centre, Galway, Ireland.
Gilvarry M; Cerenovus, Galway Neuro Technology Centre, Galway, Ireland.
Ceder E; Department of Interventional and Diagnostic Neuroradiology, Sahlgrenska University Hospital, Institute of Clinical Sciences, Gothenburg, Sweden; Department of Radiology, Sahlgrenska Academy at University of Gothenburg, Sweden.
Dehlfors N; Department of Interventional and Diagnostic Neuroradiology, Sahlgrenska University Hospital, Institute of Clinical Sciences, Gothenburg, Sweden; Department of Radiology, Sahlgrenska Academy at University of Gothenburg, Sweden.
Dunker D; Department of Interventional and Diagnostic Neuroradiology, Sahlgrenska University Hospital, Institute of Clinical Sciences, Gothenburg, Sweden; Department of Radiology, Sahlgrenska Academy at University of Gothenburg, Sweden.
Nordanstig A; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Redfors P; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Jood K; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Magoufis G; Metropolitan Hospital, Stroke Unit, Piraeus, Greece.
Psychogios K; Metropolitan Hospital, Stroke Unit, Piraeus, Greece; Second Department of Neurology, 'Attikon' University Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece.
Tsivgoulis G; Second Department of Neurology, 'Attikon' University Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece.
Alderson J; Department of Radiology, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.
O'Hare A; Department of Radiology, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.
Power S; Department of Radiology, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.
Brennan P; Department of Radiology, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.
Nagy A; Department of Neurointerventions, National Institute of Neurosciences, Budapest, Hungary.
Vadász Á; Department of Neurointerventions, National Institute of Neurosciences, Budapest, Hungary.
Brinjikji W; Department of Radiology, Mayo Clinic, Rochester, MN, USA.
Kallmes D; Department of Radiology, Mayo Clinic, Rochester, MN, USA.
Szikora I; Department of Neurointerventions, National Institute of Neurosciences, Budapest, Hungary.
Tatlisumak T; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Rentzos A; Department of Interventional and Diagnostic Neuroradiology, Sahlgrenska University Hospital, Institute of Clinical Sciences, Gothenburg, Sweden; Department of Radiology, Sahlgrenska Academy at University of Gothenburg, Sweden.
Thornton J; Department of Radiology, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.
Doyle KM; Department of Physiology, National University of Ireland Galway, Galway, Ireland; CÚRAM-SFI Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland.
Źródło:: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association [J Stroke Cerebrovasc Dis] 2021 Jan; Vol. 30 (1), pp. 105463. Date of Electronic Publication: 2020 Nov 24.
Typ publikacji:: Comparative Study; Journal Article; Multicenter Study
Język:: English
Imprint Name(s):: Publication: Philadelphia, PA : Saunders
Original Publication: New York, NY : Demos Publications, [1991-
MeSH Terms:: Endovascular Procedures*/adverse effects
Thrombectomy*/adverse effects
Thrombolytic Therapy*/adverse effects
Atherosclerosis/*therapy
Ischemic Stroke/*therapy
Atherosclerosis/complications ; Atherosclerosis/diagnostic imaging ; Atherosclerosis/physiopathology ; Cerebrovascular Circulation ; Europe ; Humans ; Ischemic Stroke/diagnostic imaging ; Ischemic Stroke/etiology ; Ischemic Stroke/physiopathology ; Registries ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome ; Vascular Patency
Grant Information:: R01 NS105853 United States NS NINDS NIH HHS
Contributed Indexing:: Keywords: Acute ischemic stroke; Etiology; Thrombectomy; Thrombolysis
Entry Date(s):: Date Created: 20201126 Date Completed: 20210104 Latest Revision: 20220102
Update Code:: 20240105
PubMed Central ID:: PMC7755299
DOI:: 10.1016/j.jstrokecerebrovasdis.2020.105463
PMID:: 33242780
: Czasopismo naukowe

Full Text Finder

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 mm 2 , Cardioembolic=52 mm 2 , Cryptogenic=47 mm 2 and Other=52 mm 2 (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.
Competing Interests: Declaration of Competing Interest 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.
(Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

Informacja