Thrombus burden is associated with clinical outcome after intra-arterial therapy for acute ischemic stroke

Andrew D. Barreto, Karen C. Albright, Hen Hallevi, James C. Grotta, Elizabeth A. Noser, Aslam M. Khaja, Hashem Shaltoni, Nicole R. Gonzales, Kachi Illoh, Sheryl Martin-Schild, Morgan S. Campbell, Raymond U. Weir, Sean I. Savitz

Research output: Contribution to journalArticle

61 Citations (Scopus)

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. 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). 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). 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.

Original languageEnglish (US)
Pages (from-to)3231-3235
Number of pages5
JournalStroke
Volume39
Issue number12
DOIs
StatePublished - Dec 1 2008
Externally publishedYes

Fingerprint

Thrombosis
Stroke
Intracranial Hemorrhages
National Institutes of Health (U.S.)
Therapeutics
Mechanical Thrombolysis
Myocardial Infarction
Mortality
Angioplasty
Stents
Multivariate Analysis
Arteries
Databases

Keywords

  • Angiography
  • Endovascular treatment
  • Outcome
  • Stroke
  • Thrombolysis
  • Thrombosis
  • Thrombus burden

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Barreto, A. D., Albright, K. C., Hallevi, H., Grotta, J. C., Noser, E. A., Khaja, A. M., ... Savitz, S. I. (2008). Thrombus burden is associated with clinical outcome after intra-arterial therapy for acute ischemic stroke. Stroke, 39(12), 3231-3235. https://doi.org/10.1161/STROKEAHA.108.521054

Thrombus burden is associated with clinical outcome after intra-arterial therapy for acute ischemic stroke. / Barreto, Andrew D.; Albright, Karen C.; Hallevi, Hen; Grotta, James C.; Noser, Elizabeth A.; Khaja, Aslam M.; Shaltoni, Hashem; Gonzales, Nicole R.; Illoh, Kachi; Martin-Schild, Sheryl; Campbell, Morgan S.; Weir, Raymond U.; Savitz, Sean I.

In: Stroke, Vol. 39, No. 12, 01.12.2008, p. 3231-3235.

Research output: Contribution to journalArticle

Barreto, AD, Albright, KC, Hallevi, H, Grotta, JC, Noser, EA, Khaja, AM, Shaltoni, H, Gonzales, NR, Illoh, K, Martin-Schild, S, Campbell, MS, Weir, RU & Savitz, SI 2008, 'Thrombus burden is associated with clinical outcome after intra-arterial therapy for acute ischemic stroke', Stroke, vol. 39, no. 12, pp. 3231-3235. https://doi.org/10.1161/STROKEAHA.108.521054
Barreto AD, Albright KC, Hallevi H, Grotta JC, Noser EA, Khaja AM et al. Thrombus burden is associated with clinical outcome after intra-arterial therapy for acute ischemic stroke. Stroke. 2008 Dec 1;39(12):3231-3235. https://doi.org/10.1161/STROKEAHA.108.521054
Barreto, Andrew D. ; Albright, Karen C. ; Hallevi, Hen ; Grotta, James C. ; Noser, Elizabeth A. ; Khaja, Aslam M. ; Shaltoni, Hashem ; Gonzales, Nicole R. ; Illoh, Kachi ; Martin-Schild, Sheryl ; Campbell, Morgan S. ; Weir, Raymond U. ; Savitz, Sean I. / Thrombus burden is associated with clinical outcome after intra-arterial therapy for acute ischemic stroke. In: Stroke. 2008 ; Vol. 39, No. 12. pp. 3231-3235.
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T1 - Thrombus burden is associated with clinical outcome after intra-arterial therapy for acute ischemic stroke

AU - Barreto, Andrew D.

AU - Albright, Karen C.

AU - Hallevi, Hen

AU - Grotta, James C.

AU - Noser, Elizabeth A.

AU - Khaja, Aslam M.

AU - Shaltoni, Hashem

AU - Gonzales, Nicole R.

AU - Illoh, Kachi

AU - Martin-Schild, Sheryl

AU - Campbell, Morgan S.

AU - Weir, Raymond U.

AU - Savitz, Sean I.

PY - 2008/12/1

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N2 - 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. 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). 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). 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.

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KW - Angiography

KW - Endovascular treatment

KW - Outcome

KW - Stroke

KW - Thrombolysis

KW - Thrombosis

KW - Thrombus burden

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