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Ischemic stroke
Original research
Thrombus enhancement sign on CT angiography is associated with the first pass effect of stent retrievers
  1. Guangchen He1,
  2. Jiangshan Deng2,
  3. Haitao Lu1,
  4. Liming Wei1,
  5. Yuwu Zhao2,
  6. Yueqi Zhu1,
  7. Yuehua Li1
  1. 1 Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
  2. 2 Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
  1. Correspondence to Dr Yueqi Zhu, Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China; zhuyueqi{at}hotmail.com; Dr Yuehua Li; liyuehua312{at}163.com

Abstract

Background The thrombus enhancement sign (TES) is thought to be associated with the source of the stroke and thrombus composition. We investigated whether this imaging sign along with other thrombus characteristics could be used to predict the successful first pass effect (FPE) of mechanical thrombectomy.

Methods 246 consecutive patients with acute ischemic stroke in the anterior circulation with large vessel occlusion who underwent thrombectomy with a stent retriever and clot collection were included. Patients were divided into FPE (modified Thrombolysis in Cerebral Infarction (mTICI) grade 2c or 3)/non-FPE (mTICI 0–2b) and modified FPE (mFPE) (mTICI 2b–3)/non-mFPE (mTICI 0–2a) groups based on flow restoration after the first pass. TES presence, thrombus density, thrombus length, clot burden score, and thrombus composition were compared. The association between FPE and imaging biomarkers, along with clinical and interventional parameters, was investigated by univariate and multivariate analysis.

Results FPE was achieved in 85 (34.6%) patients. TES presence was significantly lower in the FPE group (64.7% vs 80.7% in the non-FPE group, p=0.008) and mFPE group (69.1% vs 81.0% in the non-mFPE group, p=0.039). Histopathological examination revealed that TES (+) thrombi contained a higher fibrin/platelet proportion (50.9% vs 46.9% in TES (−) thrombi, p=0.029) and fewer erythrocytes (43.3% vs 47.3% in TES (−) thrombi, p=0.030). Thrombus characteristics, namely shorter thrombus length (p=0.032), higher erythrocyte proportions (p=0.026), and less fibrin/platelets (p=0.014), were confirmed in patients with FPE. In multivariable analysis, TES was the only independent predictor of FPE failure (OR 0.51, 95% CI 0.28 to 0.94; p=0.031).

Conclusions TES was independently associated with first pass angiographic failure in patients treated with a stent retriever.

  • thrombectomy
  • stroke
  • CT angiography

Data availability statement

Data are available upon reasonable request. Not applicable.

https://doi.org/10.1136/neurintsurg-2021-018447

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    Data availability statement

    Data are available upon reasonable request. Not applicable.

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    Footnotes

    • GH and JD contributed equally.

    • Contributors GH and JD: acquisition of the data, analysis and interpretation of the data, and drafting of the manuscript. YL and YZhu: study concept and design, critical revision of the manuscript for important intellectual content, and study supervision. HL, LW, and YZhao: acquisition of the data and revision of the manuscript. GH: statistical analysis. YZhu: responsible for the overall content as the guarantor.

    • Funding This study was supported by Shanghai Municipal Education Commission (Gaofeng Clinical Medicine grant support No 20152528) and Shanghai Jiao Tong University Medical and Research Program (ZH2018ZDA19).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.