TY - JOUR
T1 - Thrombus migration in emergent M1 middle cerebral artery occlusion
AU - Pikija, Slaven
AU - Killer-Oberpfalzer, Monika
AU - Pfaff, Johannes A R
AU - Griessenauer, Christoph J
AU - Sonnberger, Michael
AU - Vosko, Milan
AU - Mutzenbach, Johannes S
AU - Schwarzenhofer, Daniel
AU - Constantin, Hecker
N1 - Pikija, Killer-Oberpfalzer, Mutzenbach: Department of Neurology, University Hospital Salzburg, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Killer-Oberpfalzer, Constantin: Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria; Pfaff: Department of Neuroradiology, University Hospital Salzburg, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Griessenauer, Constantin: Department of Neurosurgery, University Hospital Salzburg, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria:
PY - 2024/2
Y1 - 2024/2
N2 - BACKGROUND AND PURPOSE: Thrombus migration (TM) is a well-established phenomenon in patients with intracranial vessel occlusion, particularly in those who receive alteplase. However, the relationship between TM, reperfusion success, and clinic-radiological outcomes is still being determined. This study aimed to describe the various outcomes in the event of TM in patients with M1 middle cerebral artery (M1 MCA) occlusion.MATERIALS AND METHODS: The study involved a retrospective analysis of patients undergoing endovascular thrombectomy (EVT) due to M1 MCA occlusion from two tertiary centers between January 2015 and December 2020. The proximal positions of thrombi were measured using a curve tool on CT or MR angiography before EVT. Subsequently, measurements were taken on angiographic imaging. Patients were grouped based on the amount of difference between the two measurements: growth (≤ - 10 mm), stability (> -10 mm and ≤ 10 mm), migration (> 10 mm), and resolution.RESULTS: A total of 463 patients (266 [57%] females, median 76 [interquartile range IQR: 65-83] years) were analyzed. Of them, 106 (22.8%) expressed any degree of TM. In multivariate ordinal regression analysis, the alteplase was significantly associated with TM (t = 2.192, p = 0.028), as was the greater interval from first imaging to angiography (t = 2.574, p = 0.010). In multivariate logistical regression analysis, the good clinical outcome measured by the modified Rankin scale (0-2) was not associated with TM status.CONCLUSIONS: Thrombus migration within the M1 MCA segment occurs in almost a quarter of patients, is associated with alteplase administration, and is mainly irrelevant to radiological and clinical outcome.
AB - BACKGROUND AND PURPOSE: Thrombus migration (TM) is a well-established phenomenon in patients with intracranial vessel occlusion, particularly in those who receive alteplase. However, the relationship between TM, reperfusion success, and clinic-radiological outcomes is still being determined. This study aimed to describe the various outcomes in the event of TM in patients with M1 middle cerebral artery (M1 MCA) occlusion.MATERIALS AND METHODS: The study involved a retrospective analysis of patients undergoing endovascular thrombectomy (EVT) due to M1 MCA occlusion from two tertiary centers between January 2015 and December 2020. The proximal positions of thrombi were measured using a curve tool on CT or MR angiography before EVT. Subsequently, measurements were taken on angiographic imaging. Patients were grouped based on the amount of difference between the two measurements: growth (≤ - 10 mm), stability (> -10 mm and ≤ 10 mm), migration (> 10 mm), and resolution.RESULTS: A total of 463 patients (266 [57%] females, median 76 [interquartile range IQR: 65-83] years) were analyzed. Of them, 106 (22.8%) expressed any degree of TM. In multivariate ordinal regression analysis, the alteplase was significantly associated with TM (t = 2.192, p = 0.028), as was the greater interval from first imaging to angiography (t = 2.574, p = 0.010). In multivariate logistical regression analysis, the good clinical outcome measured by the modified Rankin scale (0-2) was not associated with TM status.CONCLUSIONS: Thrombus migration within the M1 MCA segment occurs in almost a quarter of patients, is associated with alteplase administration, and is mainly irrelevant to radiological and clinical outcome.
KW - Female
KW - Humans
KW - Infarction, Middle Cerebral Artery/diagnostic imaging
KW - Magnetic Resonance Angiography
KW - Male
KW - Retrospective Studies
KW - Thrombosis
KW - Tissue Plasminogen Activator/therapeutic use
KW - Vascular Diseases
KW - Endovascular thrombectomy
KW - Migration
KW - Thrombus
KW - Ischemic stroke
KW - Thrombolysis
U2 - 10.1016/j.clineuro.2024.108132
DO - 10.1016/j.clineuro.2024.108132
M3 - Original Article
C2 - 38310761
SN - 0303-8467
VL - 237
SP - 108132
JO - CLINICAL NEUROLOGY AND NEUROSURGERY
JF - CLINICAL NEUROLOGY AND NEUROSURGERY
ER -