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

Seán Fitzgerald; Rosanna Rossi; Oana Madalina Mereuta; Sara Molina; Adaobi Okolo; Andrew Douglas; Duaa Jabrah; Abhay Pandit; Ray McCarthy; Michael Gilvarry; Erik Ceder; Niclas Dehlfors; Dennis Dunker; Annika Nordanstig; Petra Redfors; Katarina Jood; Georgios Magoufis; Klearchos Psychogios; Georgios Tsivgoulis; Jack Alderson; Alan O'Hare; Sarah Power; Paul Brennan; András Nagy; Ágnes Vadász; Waleed Brinjikji; David Kallmes; Istvan Szikora; Turgut Tatlisumak; Alexandros Rentzos; John Thornton; Karen M. Doyle

doi:10.1016/j.jstrokecerebrovasdis.2020.105463

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

Seán Fitzgerald, Rosanna Rossi, Oana Madalina Mereuta, Sara Molina, Adaobi Okolo, Andrew Douglas, Duaa Jabrah, Abhay Pandit, Ray McCarthy, Michael Gilvarry, Erik Ceder, Niclas Dehlfors, Dennis Dunker, Annika Nordanstig, Petra Redfors, Katarina Jood, Georgios Magoufis, Klearchos Psychogios, Georgios Tsivgoulis, Jack AldersonAlan O'Hare, Sarah Power, Paul Brennan, András Nagy, Ágnes Vadász, Waleed Brinjikji, David Kallmes, Istvan Szikora, Turgut Tatlisumak, Alexandros Rentzos, John Thornton, Karen M. Doyle

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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.

Idioma original	Anglès
Número d’article	105463
Revista	Journal of Stroke and Cerebrovascular Diseases
Volum	30
Número	1
DOIs	https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105463
Estat de la publicació	Publicada - de gen. 2021

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Fitzgerald, S., Rossi, R., Mereuta, O. M., Molina, S., Okolo, A., Douglas, A., Jabrah, D., Pandit, A., McCarthy, R., Gilvarry, M., Ceder, E., Dehlfors, N., Dunker, D., Nordanstig, A., Redfors, P., Jood, K., Magoufis, G., Psychogios, K., Tsivgoulis, G., ... Doyle, K. M. (2021). Large Artery Atherosclerotic Clots are Larger than Clots of other Stroke Etiologies and have Poorer Recanalization rates. Journal of Stroke and Cerebrovascular Diseases, 30(1), Article 105463. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105463

@article{4da09c3e5ec746ebbbc91311bc92c500,

title = "Large Artery Atherosclerotic Clots are Larger than Clots of other Stroke Etiologies and have Poorer Recanalization rates",

abstract = "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.",

author = "Se{\'a}n Fitzgerald and Rosanna Rossi and Mereuta, \{Oana Madalina\} and Sara Molina and Adaobi Okolo and Andrew Douglas and Duaa Jabrah and Abhay Pandit and Ray McCarthy and Michael Gilvarry and Erik Ceder and Niclas Dehlfors and Dennis Dunker and Annika Nordanstig and Petra Redfors and Katarina Jood and Georgios Magoufis and Klearchos Psychogios and Georgios Tsivgoulis and Jack Alderson and Alan O'Hare and Sarah Power and Paul Brennan and Andr{\'a}s Nagy and {\'A}gnes Vad{\'a}sz and Waleed Brinjikji and David Kallmes and Istvan Szikora and Turgut Tatlisumak and Alexandros Rentzos and John Thornton and Doyle, \{Karen M.\}",

year = "2021",

month = jan,

doi = "10.1016/j.jstrokecerebrovasdis.2020.105463",

language = "English",

volume = "30",

journal = "Journal of Stroke and Cerebrovascular Diseases",

issn = "1052-3057",

publisher = "W.B. Saunders",

number = "1",

}

Fitzgerald, S, Rossi, R, Mereuta, OM, Molina, S, Okolo, A, Douglas, A, Jabrah, D, Pandit, A, McCarthy, R, Gilvarry, M, Ceder, E, Dehlfors, N, Dunker, D, Nordanstig, A, Redfors, P, Jood, K, Magoufis, G, Psychogios, K, Tsivgoulis, G, Alderson, J, O'Hare, A, Power, S, Brennan, P, Nagy, A, Vadász, Á, Brinjikji, W, Kallmes, D, Szikora, I, Tatlisumak, T, Rentzos, A, Thornton, J & Doyle, KM 2021, 'Large Artery Atherosclerotic Clots are Larger than Clots of other Stroke Etiologies and have Poorer Recanalization rates', Journal of Stroke and Cerebrovascular Diseases, vol. 30, núm. 1, 105463. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105463

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.

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.

UR - https://www.scopus.com/pages/publications/85096644485

U2 - 10.1016/j.jstrokecerebrovasdis.2020.105463

DO - 10.1016/j.jstrokecerebrovasdis.2020.105463

M3 - Article

SN - 1052-3057

VL - 30

JO - Journal of Stroke and Cerebrovascular Diseases

JF - Journal of Stroke and Cerebrovascular Diseases

IS - 1

M1 - 105463

ER -

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

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