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Thrombus burden is associated with clinical outcome after intra-arterial therapy for acute ischemic stroke.
- Source :
-
Stroke [Stroke] 2008 Dec; Vol. 39 (12), pp. 3231-5. Date of Electronic Publication: 2008 Sep 04. - Publication Year :
- 2008
-
Abstract
- Background and Purpose: Studies have established a relation between recanalization and improved clinical outcome in acute ischemic stroke patients; however, intra-arterial clot size has not been routinely assessed. The aim of the study was to determine the impact of intra-arterial thrombus burden on intra-arterial treatment (IAT) and clinical outcome.<br />Methods: A retrospective review of our IAT stroke database included procedure time, recanalization, symptomatic intracranial hemorrhage, poor outcome (modified Rankin Scale score >/=4 at discharge), and mortality. The modified Thrombolysis in Myocardial Infarction thrombus grade was dichotomized into grades 0 to 3 (no clot or moderate thrombus, <2 vessel diameters) versus grade 4 (large thrombus, >2 vessel diameters).<br />Results: Data were collected on 135 patients with thrombus grading. The baseline median National Institutes of Health Stroke Scale score was higher in patients of grade 4 compared with grades 0 to 3 (19 vs 17, P=0.012). Grade 4 thrombi required longer (median, range) times for IAT (113, 37 to 415 minutes vs 74, 22 to 215 minutes, respectively; P<0.001) and higher rates of mechanical clot disruption (wire, angioplasty, snare, stent, or Merci retriever) compared with grades 0 to 3 (76% vs 53%, P=0.005). There were no differences in rates of symptomatic intracranial hemorrhage (6.6% vs 4.1%, P=0.701) or recanalization (50% vs 61%, P=0.216) in grade 4 versus grades 0 to 3. Multivariate analysis adjusted for age, baseline National Institutes of Health Stroke Scale score, and artery of involvement showed that grade 4 thrombi were independently associated with poor outcome (odds ratio=2.4; 95% CI, 1.06 to 5.57; P=0.036) and mortality (odds ratio=4.0; 95% CI, 1.2 to 13.2; P=0.023).<br />Conclusions: High thrombus grade as measured by the modified Thrombolysis in Myocardial Infarction criteria may be a risk factor that contributes to poor clinical outcome.
- Subjects :
- Aged
Brain Damage, Chronic epidemiology
Brain Damage, Chronic etiology
Brain Damage, Chronic prevention & control
Brain Ischemia etiology
Cerebral Angiography
Cerebral Hemorrhage chemically induced
Cerebral Hemorrhage epidemiology
Combined Modality Therapy
Female
Fibrinolytic Agents administration & dosage
Fibrinolytic Agents adverse effects
Fibrinolytic Agents therapeutic use
Humans
Infusions, Intra-Arterial
Intracranial Thrombosis complications
Intracranial Thrombosis diagnostic imaging
Intracranial Thrombosis drug therapy
Intracranial Thrombosis pathology
Male
Middle Aged
Reperfusion
Retrospective Studies
Severity of Illness Index
Stents
Thrombolytic Therapy adverse effects
Thrombolytic Therapy statistics & numerical data
Treatment Outcome
Angioplasty instrumentation
Angioplasty methods
Angioplasty statistics & numerical data
Brain Ischemia pathology
Intracranial Thrombosis surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1524-4628
- Volume :
- 39
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Stroke
- Publication Type :
- Academic Journal
- Accession number :
- 18772444
- Full Text :
- https://doi.org/10.1161/STROKEAHA.108.521054