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 M. Shaltoni, Nicole R. Gonzales, Kachi Illoh, Sheryl Martin-Schild, Morgan S. Campbell, Raymond U. Weir, Sean I. Savitz

Research output: Contribution to journalArticle

63 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

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

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    Barreto, A. D., Albright, K. C., Hallevi, H., Grotta, J. C., Noser, E. A., Khaja, A. M., Shaltoni, H. M., Gonzales, N. R., Illoh, K., Martin-Schild, S., Campbell, M. S., Weir, R. U., & 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