Value of Thrombus Imaging Characteristics as a Guide for First‐Line Endovascular Thrombectomy Device in Patients With Acute Ischemic Stroke
Background It has been suggested that selection of a first‐line endovascular thrombectomy device, that is, contact aspiration (CA) or stent retriever (SR) thrombectomy, could be based on thrombus type. Thrombus composition and mechanical behavior can partially be predicted with thrombus computed tom...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-01-01
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| Series: | Stroke: Vascular and Interventional Neurology |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/SVIN.122.000450 |
| _version_ | 1797258500022206464 |
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| author | Nikki Boodt Agnetha A. E. Bruggeman Manon Kappelhof Sanne J. den Hartog Nerea Arrarte Terreros Jasper M. Martens Reinoud P. H. Bokkers Pieter‐Jan van Doormaal Charles B. L. M. Majoie Wim H. van Zwam Henk A. Marquering Diederik W. J. Dippel Aad van der Lugt Hester F. Lingsma |
| author_facet | Nikki Boodt Agnetha A. E. Bruggeman Manon Kappelhof Sanne J. den Hartog Nerea Arrarte Terreros Jasper M. Martens Reinoud P. H. Bokkers Pieter‐Jan van Doormaal Charles B. L. M. Majoie Wim H. van Zwam Henk A. Marquering Diederik W. J. Dippel Aad van der Lugt Hester F. Lingsma |
| author_sort | Nikki Boodt |
| collection | DOAJ |
| description | Background It has been suggested that selection of a first‐line endovascular thrombectomy device, that is, contact aspiration (CA) or stent retriever (SR) thrombectomy, could be based on thrombus type. Thrombus composition and mechanical behavior can partially be predicted with thrombus computed tomography (CT) characteristics. We aimed to assess the influence of thrombus CT characteristics on the association between first‐line device and outcomes of endovascular thrombectomy. Methods For patients enrolled in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands) Registry between March 2014 and November 2017, we assessed thrombus density, thrombus length, and presence of hyperdense artery sign on thin‐slice (≤2.5 mm) admission CT. We used regression models to estimate the relationship between first‐line endovascular thrombectomy device (CA versus stent retriever) and first‐pass reperfusion (FPR, expanded Thrombolysis in Cerebral Infarction score 2C‐3 after first attempt), final reperfusion, procedure duration, 24‐hour National Institutes of Health Stroke Scale, and 90‐day modified Rankin scale score and tested for interaction of thrombus characteristics with first‐line device by adding interaction terms. Results Of 703 included patients, 520 (74%) received first‐line stent retriever and 183 (26%) first‐line CA. Overall, the first‐line device was not associated with FPR (adjusted odds ratio [aOR], 1.32 [95% CI, 0.88–1.98]). In patients with thrombus density below the median (<50 Hounsfield units), FPR was more often achieved with CA than with a stent retriever (34% versus 24%, aOR, 1.95 [95% CI, 1.09–3.50]), whereas in patients with thrombus density above the median (≥50 Hounsfield units), first‐line device was not associated with FPR (aOR, 0.90 [95% CI, 0.50–1.62]). The interaction between thrombus density as a continuous variable and first‐line device on outcome was not significant (P=0.38). There was also no interaction between first‐line device and the other thrombus characteristics for FPR or the other outcomes. Conclusion Our study does not provide evidence that the association between first‐line thrombectomy device and endovascular thrombectomy outcomes depends on thrombus CT characteristics. Based on our results, there are no arguments for thrombectomy device selection based on thrombus CT characteristics. A possible better performance of CA in low‐density, fibrin‐rich clots needs further study. |
| first_indexed | 2024-03-08T18:28:27Z |
| format | Article |
| id | doaj.art-286a9e9b159146c491edb3a1f0db903d |
| institution | Directory Open Access Journal |
| issn | 2694-5746 |
| language | English |
| last_indexed | 2024-04-24T22:54:31Z |
| publishDate | 2023-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Stroke: Vascular and Interventional Neurology |
| spelling | doaj.art-286a9e9b159146c491edb3a1f0db903d2024-03-18T06:39:33ZengWileyStroke: Vascular and Interventional Neurology2694-57462023-01-013110.1161/SVIN.122.000450Value of Thrombus Imaging Characteristics as a Guide for First‐Line Endovascular Thrombectomy Device in Patients With Acute Ischemic StrokeNikki Boodt0Agnetha A. E. Bruggeman1Manon Kappelhof2Sanne J. den Hartog3Nerea Arrarte Terreros4Jasper M. Martens5Reinoud P. H. Bokkers6Pieter‐Jan van Doormaal7Charles B. L. M. Majoie8Wim H. van Zwam9Henk A. Marquering10Diederik W. J. Dippel11Aad van der Lugt12Hester F. Lingsma13Department of Radiology and Nuclear Medicine Erasmus MC, University Medical Center Rotterdam Rotterdam The NetherlandsDepartment of Radiology and Nuclear Medicine Amsterdam UMC, University of Amsterdam Amsterdam The NetherlandsDepartment of Radiology and Nuclear Medicine Amsterdam UMC, University of Amsterdam Amsterdam The NetherlandsDepartment of Radiology and Nuclear Medicine Erasmus MC, University Medical Center Rotterdam Rotterdam The NetherlandsDepartment of Radiology and Nuclear Medicine Amsterdam UMC, University of Amsterdam Amsterdam The NetherlandsDepartment of Radiology and Nuclear Medicine Rijnstate Hospital Arnhem The NetherlandsMedical Imaging Center, Department of Radiology Groningen University of Groningen University Medical Center Groningen Groningen The NetherlandsDepartment of Radiology and Nuclear Medicine Erasmus MC, University Medical Center Rotterdam Rotterdam The NetherlandsDepartment of Radiology and Nuclear Medicine Amsterdam UMC, University of Amsterdam Amsterdam The NetherlandsDepartment of Radiology and Nuclear Medicine Cardiovascular Research Institute Maastricht (CARIM) Maastricht University Medical Center Maastricht The NetherlandsDepartment of Radiology and Nuclear Medicine Amsterdam UMC, University of Amsterdam Amsterdam The NetherlandsDepartment of Neurology Erasmus MC, University Medical Center Rotterdam Rotterdam The NetherlandsDepartment of Radiology and Nuclear Medicine Erasmus MC, University Medical Center Rotterdam Rotterdam The NetherlandsDepartment of Public Health Erasmus MC, University Medical Center Rotterdam Rotterdam The NetherlandsBackground It has been suggested that selection of a first‐line endovascular thrombectomy device, that is, contact aspiration (CA) or stent retriever (SR) thrombectomy, could be based on thrombus type. Thrombus composition and mechanical behavior can partially be predicted with thrombus computed tomography (CT) characteristics. We aimed to assess the influence of thrombus CT characteristics on the association between first‐line device and outcomes of endovascular thrombectomy. Methods For patients enrolled in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands) Registry between March 2014 and November 2017, we assessed thrombus density, thrombus length, and presence of hyperdense artery sign on thin‐slice (≤2.5 mm) admission CT. We used regression models to estimate the relationship between first‐line endovascular thrombectomy device (CA versus stent retriever) and first‐pass reperfusion (FPR, expanded Thrombolysis in Cerebral Infarction score 2C‐3 after first attempt), final reperfusion, procedure duration, 24‐hour National Institutes of Health Stroke Scale, and 90‐day modified Rankin scale score and tested for interaction of thrombus characteristics with first‐line device by adding interaction terms. Results Of 703 included patients, 520 (74%) received first‐line stent retriever and 183 (26%) first‐line CA. Overall, the first‐line device was not associated with FPR (adjusted odds ratio [aOR], 1.32 [95% CI, 0.88–1.98]). In patients with thrombus density below the median (<50 Hounsfield units), FPR was more often achieved with CA than with a stent retriever (34% versus 24%, aOR, 1.95 [95% CI, 1.09–3.50]), whereas in patients with thrombus density above the median (≥50 Hounsfield units), first‐line device was not associated with FPR (aOR, 0.90 [95% CI, 0.50–1.62]). The interaction between thrombus density as a continuous variable and first‐line device on outcome was not significant (P=0.38). There was also no interaction between first‐line device and the other thrombus characteristics for FPR or the other outcomes. Conclusion Our study does not provide evidence that the association between first‐line thrombectomy device and endovascular thrombectomy outcomes depends on thrombus CT characteristics. Based on our results, there are no arguments for thrombectomy device selection based on thrombus CT characteristics. A possible better performance of CA in low‐density, fibrin‐rich clots needs further study.https://www.ahajournals.org/doi/10.1161/SVIN.122.000450acute strokeaspirationstent retrieverthrombectomythrombus |
| spellingShingle | Nikki Boodt Agnetha A. E. Bruggeman Manon Kappelhof Sanne J. den Hartog Nerea Arrarte Terreros Jasper M. Martens Reinoud P. H. Bokkers Pieter‐Jan van Doormaal Charles B. L. M. Majoie Wim H. van Zwam Henk A. Marquering Diederik W. J. Dippel Aad van der Lugt Hester F. Lingsma Value of Thrombus Imaging Characteristics as a Guide for First‐Line Endovascular Thrombectomy Device in Patients With Acute Ischemic Stroke Stroke: Vascular and Interventional Neurology acute stroke aspiration stent retriever thrombectomy thrombus |
| title | Value of Thrombus Imaging Characteristics as a Guide for First‐Line Endovascular Thrombectomy Device in Patients With Acute Ischemic Stroke |
| title_full | Value of Thrombus Imaging Characteristics as a Guide for First‐Line Endovascular Thrombectomy Device in Patients With Acute Ischemic Stroke |
| title_fullStr | Value of Thrombus Imaging Characteristics as a Guide for First‐Line Endovascular Thrombectomy Device in Patients With Acute Ischemic Stroke |
| title_full_unstemmed | Value of Thrombus Imaging Characteristics as a Guide for First‐Line Endovascular Thrombectomy Device in Patients With Acute Ischemic Stroke |
| title_short | Value of Thrombus Imaging Characteristics as a Guide for First‐Line Endovascular Thrombectomy Device in Patients With Acute Ischemic Stroke |
| title_sort | value of thrombus imaging characteristics as a guide for first line endovascular thrombectomy device in patients with acute ischemic stroke |
| topic | acute stroke aspiration stent retriever thrombectomy thrombus |
| url | https://www.ahajournals.org/doi/10.1161/SVIN.122.000450 |
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