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Impact of Clot Shape on Successful M1 Endovascular Reperfusion
Objectives: The susceptibility-vessel-sign (SVS) allows thrombus visualization, length estimation and composition, and it may impact reperfusion during mechanical thrombectomy (MT). SVS can also describe thrombus shape in the occluded artery: in the straight M1-segment (S-shaped), or in an angulated...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7882685/ https://www.ncbi.nlm.nih.gov/pubmed/33597919 http://dx.doi.org/10.3389/fneur.2021.642877 |
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author | Guenego, Adrien Fahed, Robert Sussman, Eric S. Leipzig, Matthew Albers, Gregory W. Martin, Blake W. Marcellus, David G. Kuraitis, Gabriella Marks, Michael P. Lansberg, Maarten G. Wintermark, Max Heit, Jeremy J. |
author_facet | Guenego, Adrien Fahed, Robert Sussman, Eric S. Leipzig, Matthew Albers, Gregory W. Martin, Blake W. Marcellus, David G. Kuraitis, Gabriella Marks, Michael P. Lansberg, Maarten G. Wintermark, Max Heit, Jeremy J. |
author_sort | Guenego, Adrien |
collection | PubMed |
description | Objectives: The susceptibility-vessel-sign (SVS) allows thrombus visualization, length estimation and composition, and it may impact reperfusion during mechanical thrombectomy (MT). SVS can also describe thrombus shape in the occluded artery: in the straight M1-segment (S-shaped), or in an angulated/traversing a bifurcation segment (A-shaped). We determined whether SVS clot shape influenced reperfusion and outcomes after MT for proximal middle-cerebral-artery (M1) occlusions. Methods: Between May 2015 and March 2018, consecutive patients who underwent MT at one comprehensive stroke center and who had a baseline MRI with a T2(*) sequence were included. Clinical, procedural and radiographic data, including clot shape on SVS [angulated/bifurcation (A-SVS) vs. straight (S-SVS)] and length were assessed. Primary outcome was successful reperfusion (TICI 2b-3). Secondary outcome were MT complication rates, MT reperfusion time, and clinical outcome at 90-days. Predictors of outcome were assessed with univariate and multivariate analyses. Results: A total of 62 patients were included. 56% (35/62) had an A-SVS. Clots were significantly longer in the A-SVS group (19 mm vs. 8 mm p = 0.0002). Groups were otherwise well-matched with regard to baseline characteristics. There was a significantly lower rate of successful reperfusion in the A-SVS cohort (83%) compared to the S-SVS cohort (96%) in multivariable analysis [OR 0.04 (95% CI, 0.002–0.58), p = 0.02]. There was no significant difference in long term clinical outcome between groups. Conclusion: Clot shape as determined on T2(*) imaging, in patients presenting with M1 occlusion appears to be a predictor of successful reperfusion after MT. Angulated and bifurcating clots are associated with poorer rates of successful reperfusion. |
format | Online Article Text |
id | pubmed-7882685 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-78826852021-02-16 Impact of Clot Shape on Successful M1 Endovascular Reperfusion Guenego, Adrien Fahed, Robert Sussman, Eric S. Leipzig, Matthew Albers, Gregory W. Martin, Blake W. Marcellus, David G. Kuraitis, Gabriella Marks, Michael P. Lansberg, Maarten G. Wintermark, Max Heit, Jeremy J. Front Neurol Neurology Objectives: The susceptibility-vessel-sign (SVS) allows thrombus visualization, length estimation and composition, and it may impact reperfusion during mechanical thrombectomy (MT). SVS can also describe thrombus shape in the occluded artery: in the straight M1-segment (S-shaped), or in an angulated/traversing a bifurcation segment (A-shaped). We determined whether SVS clot shape influenced reperfusion and outcomes after MT for proximal middle-cerebral-artery (M1) occlusions. Methods: Between May 2015 and March 2018, consecutive patients who underwent MT at one comprehensive stroke center and who had a baseline MRI with a T2(*) sequence were included. Clinical, procedural and radiographic data, including clot shape on SVS [angulated/bifurcation (A-SVS) vs. straight (S-SVS)] and length were assessed. Primary outcome was successful reperfusion (TICI 2b-3). Secondary outcome were MT complication rates, MT reperfusion time, and clinical outcome at 90-days. Predictors of outcome were assessed with univariate and multivariate analyses. Results: A total of 62 patients were included. 56% (35/62) had an A-SVS. Clots were significantly longer in the A-SVS group (19 mm vs. 8 mm p = 0.0002). Groups were otherwise well-matched with regard to baseline characteristics. There was a significantly lower rate of successful reperfusion in the A-SVS cohort (83%) compared to the S-SVS cohort (96%) in multivariable analysis [OR 0.04 (95% CI, 0.002–0.58), p = 0.02]. There was no significant difference in long term clinical outcome between groups. Conclusion: Clot shape as determined on T2(*) imaging, in patients presenting with M1 occlusion appears to be a predictor of successful reperfusion after MT. Angulated and bifurcating clots are associated with poorer rates of successful reperfusion. Frontiers Media S.A. 2021-02-01 /pmc/articles/PMC7882685/ /pubmed/33597919 http://dx.doi.org/10.3389/fneur.2021.642877 Text en Copyright © 2021 Guenego, Fahed, Sussman, Leipzig, Albers, Martin, Marcellus, Kuraitis, Marks, Lansberg, Wintermark and Heit. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Neurology Guenego, Adrien Fahed, Robert Sussman, Eric S. Leipzig, Matthew Albers, Gregory W. Martin, Blake W. Marcellus, David G. Kuraitis, Gabriella Marks, Michael P. Lansberg, Maarten G. Wintermark, Max Heit, Jeremy J. Impact of Clot Shape on Successful M1 Endovascular Reperfusion |
title | Impact of Clot Shape on Successful M1 Endovascular Reperfusion |
title_full | Impact of Clot Shape on Successful M1 Endovascular Reperfusion |
title_fullStr | Impact of Clot Shape on Successful M1 Endovascular Reperfusion |
title_full_unstemmed | Impact of Clot Shape on Successful M1 Endovascular Reperfusion |
title_short | Impact of Clot Shape on Successful M1 Endovascular Reperfusion |
title_sort | impact of clot shape on successful m1 endovascular reperfusion |
topic | Neurology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7882685/ https://www.ncbi.nlm.nih.gov/pubmed/33597919 http://dx.doi.org/10.3389/fneur.2021.642877 |
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