TY - JOUR
T1 - Distal Embolization in Relation to Radiological Thrombus Characteristics, Treatment Details, and Functional Outcome
AU - Bala, Fouzi
AU - Kappelhof, Manon
AU - Ospel, Johanna M.
AU - Cimflova, Petra
AU - Qiu, Wu
AU - Singh, Nishita
AU - Zhu, Kairan
AU - Kim, Beom Joon
AU - Wadhwa, Ankur
AU - Almekhlafi, Mohammed A.
AU - Menon, Bijoy K.
AU - Arrarte Terreros, Nerea
AU - Marquering, Henk
AU - Majoie, Charles
AU - Hill, Michael D.
AU - Goyal, Mayank
N1 - Funding Information: The ESCAPE-NA1 trial (Efficacy and Safety of Nerinetide for the Treatment of Acute Ischemic Stroke) was supported by a grant from the Canadian Institutes of Health Research by Alberta Innovates and NoNo. Funding Information: Dr Almekhlafi reports grants from Canadian Institutes of Health Research (CIHR) outside the submitted work, and serving on the scientific advisory board of Palmera Medical, Inc. Dr Marquering is shareholder of Nicolab and Trianect. Dr Menon reports shares in Circle NVI; patent for systems of triage in acute stroke. In addition, he serves as an associated editor for the Journal of Stroke, and as associate professor at the university of Calgary. Dr Hill reports grants from CIHR during the conduct of the study, grants from Medtronic, and grants from NoNO, Inc, outside the submitted work. In addition, he has a patent to US Patent office Number: 62/086,077 issued and licensed, and Director, Board of Circle Neurovascular, Director, Board of the Canadian Neuroscience Federation, and Director, Board of the Canadian Stroke Consortium. Dr Goyal reports receiving fees from Medtronic, Stryker, Microvention, GE Healthcare, and Mentice. Dr Majoie reports grants from CVON (CardioVasculair Onderzoek Nederland)/Dutch Heart Foundation, TWIN Foundation, European Commission, Healthcare Evaluation Netherlands; and is shareholder of Nicolab. Dr Ospel serves as a consultant for GE Healthcare and Nicolab. The other authors report no conflicts. Publisher Copyright: © 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/2/1
Y1 - 2023/2/1
N2 - Background: Distal embolization (DE) is a common complication of endovascular treatment (EVT). We investigated the association of radiological thrombus characteristics and treatment details with DE. Methods: Patients with thin-slice (≤2.5 mm) baseline noncontrast computed tomography and computed tomography angiography from the ESCAPE-NA1 trial (Efficacy and Safety of Nerinetide for the Treatment of Acute Ischemic Stroke) were included. Thrombus annotation was performed manually on coregistered scans by experienced readers. We assessed thrombus location, distance from internal carotid artery terminus, length, perviousness, absolute attenuation, and hyperdense artery sign. In addition, we evaluated balloon guide catheter use during EVT, first-line EVT approach, the number of thrombectomy passes, and prior intravenous thrombolysis administration. DE was defined as the occurrence of emboli distal to the target artery or in new territories during EVT. The association between thrombus characteristics, treatment details, and DE was evaluated using descriptive statistics and multivariable mixed-effects logistic regression, resulting in adjusted odds ratios (aOR) with 95% CI. Interaction between IVT and radiological thrombus characteristics was assessed by adding interaction terms in separate models. Results: In total, 496 out of 1105 (44.9%) ESCAPE-NA1 patients were included. DE was detected in 251 out of 496 patients (50.6%). Patients with DE had longer thrombi (median, 28.5 [interquartile range, 20.8-42.3] mm versus 24.4 [interquartile range, 17.1-32.4] mm; P<0.01). There were no statistically significant differences in the other thrombus characteristics. Factors associated with DE were thrombus length (aOR, 1.02 [95% CI, 1.01-1.04]), balloon guide catheter use (aOR, 0.49 [95% CI, 0.29-0.85]), and number of passes (aOR, 1.24 [95% CI, 1.04-1.47]). In patients with hyperdense artery sign, IVT was associated with reduced odds of DE (aOR, 0.55 [95% CI, 0.31-0.97]), P for interaction=0.04. Conclusions: DE was associated with longer thrombi, no balloon guide catheter use, and more EVT passes. IVT was associated with a reduced risk of DE in patients with hyperdense artery sign. These findings may support treatment decisions on IVT and EVT approaches.
AB - Background: Distal embolization (DE) is a common complication of endovascular treatment (EVT). We investigated the association of radiological thrombus characteristics and treatment details with DE. Methods: Patients with thin-slice (≤2.5 mm) baseline noncontrast computed tomography and computed tomography angiography from the ESCAPE-NA1 trial (Efficacy and Safety of Nerinetide for the Treatment of Acute Ischemic Stroke) were included. Thrombus annotation was performed manually on coregistered scans by experienced readers. We assessed thrombus location, distance from internal carotid artery terminus, length, perviousness, absolute attenuation, and hyperdense artery sign. In addition, we evaluated balloon guide catheter use during EVT, first-line EVT approach, the number of thrombectomy passes, and prior intravenous thrombolysis administration. DE was defined as the occurrence of emboli distal to the target artery or in new territories during EVT. The association between thrombus characteristics, treatment details, and DE was evaluated using descriptive statistics and multivariable mixed-effects logistic regression, resulting in adjusted odds ratios (aOR) with 95% CI. Interaction between IVT and radiological thrombus characteristics was assessed by adding interaction terms in separate models. Results: In total, 496 out of 1105 (44.9%) ESCAPE-NA1 patients were included. DE was detected in 251 out of 496 patients (50.6%). Patients with DE had longer thrombi (median, 28.5 [interquartile range, 20.8-42.3] mm versus 24.4 [interquartile range, 17.1-32.4] mm; P<0.01). There were no statistically significant differences in the other thrombus characteristics. Factors associated with DE were thrombus length (aOR, 1.02 [95% CI, 1.01-1.04]), balloon guide catheter use (aOR, 0.49 [95% CI, 0.29-0.85]), and number of passes (aOR, 1.24 [95% CI, 1.04-1.47]). In patients with hyperdense artery sign, IVT was associated with reduced odds of DE (aOR, 0.55 [95% CI, 0.31-0.97]), P for interaction=0.04. Conclusions: DE was associated with longer thrombi, no balloon guide catheter use, and more EVT passes. IVT was associated with a reduced risk of DE in patients with hyperdense artery sign. These findings may support treatment decisions on IVT and EVT approaches.
KW - angiography
KW - catheters
KW - ischemic stroke
KW - thrombectomy
KW - tomography
UR - http://www.scopus.com/inward/record.url?scp=85146622619&partnerID=8YFLogxK
U2 - https://doi.org/10.1161/STROKEAHA.122.040542
DO - https://doi.org/10.1161/STROKEAHA.122.040542
M3 - Article
C2 - 36689583
SN - 0039-2499
VL - 54
SP - 448
EP - 456
JO - Stroke
JF - Stroke
IS - 2
ER -