Clot imaging characteristics predict first pass effect of aspiration—first approach to thrombectomy
Background The value of clot imaging in patients with emergent large vessel occlusion (ELVO) treated with thrombectomy is unknown. Methods We performed retrospective analysis of clot imaging (clot density, perviousness, length, diameter, distance to the internal carotid artery (ICA) terminus and ang...
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| Veröffentlicht in: | Interventional neuroradiology 2022-04, Vol.28 (2), p.152-159 |
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| creator | Waqas, Muhammad Li, Weizhe Patel, Tatsat R Chin, Felix Tutino, Vincent M Dossani, Rimal H Ren, Zeguang Guerrero, Waldo R Borlongan, Cesario V Pressman, Elliot Snyder, Kenneth Davies, Jason M Ley, Elad I Ionita, Ciprian N Siddiqui, Adnan H Mokin, Maxim |
| description | Background
The value of clot imaging in patients with emergent large vessel occlusion (ELVO) treated with thrombectomy is unknown.
Methods
We performed retrospective analysis of clot imaging (clot density, perviousness, length, diameter, distance to the internal carotid artery (ICA) terminus and angle of interaction (AOI) between clot and the aspiration catheter) of consecutive cases of middle cerebral artery (MCA) occlusion and its association with first pass effect (FPE, TICI 2c-3 after a first attempt).
Results
Patients (n = 90 total) with FPE had shorter clot length (9.9 ± 4.5 mm vs. 11.7 ± 4.6 mm, P = 0.07), shorter distance from ICA terminus (11.0 ± 7.1 mm vs. 14.7 ± 9.8 mm, P = 0.048), higher perviousness (39.39 ± 29.5 vs 25.43 ± 17.6, P = 0.006) and larger AOI (153.6 ± 17.6 vs 140.3 ± 23.5, P = 0.004) compared to no-FPE patients. In multivariate analysis, distance from ICA terminus to clot ≤13.5 mm (odds ratio (OR) 11.05, 95% confidence interval (CI) 2.65–46.15, P = 0.001), clot length ≤9.9 mm (OR 7.34; 95% CI 1.8–29.96, P = 0.005), perviousness ≥ 19.9 (OR 2.54, 95% CI 0.84–7.6, P = 0.09) and AOI ≥ 137°^ (OR 6.8, 95% CI 1.55–29.8, P = 0.011) were independent predictors of FPE. The optimal cut off derived using Youden’s index was 6.5. The area under the curve of a score predictive of FPE success was 0.816 (0.728–0.904, P |
| doi_str_mv | 10.1177/15910199211019174 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9131505</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_15910199211019174</sage_id><sourcerecordid>2528818225</sourcerecordid><originalsourceid>FETCH-LOGICAL-c456t-531caa379b7e663d676a9a1a1ba1fff34c4e28fa6d4f256dd9339f382a2b84dd3</originalsourceid><addsrcrecordid>eNp9kc2KFDEQx4Mo7rj6AF4kRy-9ppJOOrkIMvgFC170HKrTyUyW7k6bZIS9-RA-oU9iN7MuiuCpoOpX__r4E_Ic2BVA170CaYCBMRy2AF37gOy40LLhDOAh2W31ZgMuyJNSbhhTUhh4TC5EyxjTSu-I34-p0jjhIc4H6o6Y0VWfY6nRFbpkP0RXaYi5VLpgKdSH4NdMChTLEjPWmOaf33-cCVyWnNAdaU20HnOa-pVN0-1T8ijgWPyzu3hJvrx7-3n_obn-9P7j_s1141qpaiMFOETRmb7zSolBdQoNAkKPEEIQrWs91wHV0AYu1TAYIUwQmiPvdTsM4pK8Pusup37yg_NzzTjaJa8H5lubMNq_K3M82kP6Zg0IkEyuAi_vBHL6evKl2ikW58cRZ59OxXLJtQbN-YbCGXU5lZJ9uB8DzG722H_sWXte_LnffcdvP1bg6gwUPHh7k055Xv_1H8VfcjmcMw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2528818225</pqid></control><display><type>article</type><title>Clot imaging characteristics predict first pass effect of aspiration—first approach to thrombectomy</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>SAGE Complete</source><source>PubMed Central</source><creator>Waqas, Muhammad ; Li, Weizhe ; Patel, Tatsat R ; Chin, Felix ; Tutino, Vincent M ; Dossani, Rimal H ; Ren, Zeguang ; Guerrero, Waldo R ; Borlongan, Cesario V ; Pressman, Elliot ; Snyder, Kenneth ; Davies, Jason M ; Ley, Elad I ; Ionita, Ciprian N ; Siddiqui, Adnan H ; Mokin, Maxim</creator><creatorcontrib>Waqas, Muhammad ; Li, Weizhe ; Patel, Tatsat R ; Chin, Felix ; Tutino, Vincent M ; Dossani, Rimal H ; Ren, Zeguang ; Guerrero, Waldo R ; Borlongan, Cesario V ; Pressman, Elliot ; Snyder, Kenneth ; Davies, Jason M ; Ley, Elad I ; Ionita, Ciprian N ; Siddiqui, Adnan H ; Mokin, Maxim</creatorcontrib><description>Background
The value of clot imaging in patients with emergent large vessel occlusion (ELVO) treated with thrombectomy is unknown.
Methods
We performed retrospective analysis of clot imaging (clot density, perviousness, length, diameter, distance to the internal carotid artery (ICA) terminus and angle of interaction (AOI) between clot and the aspiration catheter) of consecutive cases of middle cerebral artery (MCA) occlusion and its association with first pass effect (FPE, TICI 2c-3 after a first attempt).
Results
Patients (n = 90 total) with FPE had shorter clot length (9.9 ± 4.5 mm vs. 11.7 ± 4.6 mm, P = 0.07), shorter distance from ICA terminus (11.0 ± 7.1 mm vs. 14.7 ± 9.8 mm, P = 0.048), higher perviousness (39.39 ± 29.5 vs 25.43 ± 17.6, P = 0.006) and larger AOI (153.6 ± 17.6 vs 140.3 ± 23.5, P = 0.004) compared to no-FPE patients. In multivariate analysis, distance from ICA terminus to clot ≤13.5 mm (odds ratio (OR) 11.05, 95% confidence interval (CI) 2.65–46.15, P = 0.001), clot length ≤9.9 mm (OR 7.34; 95% CI 1.8–29.96, P = 0.005), perviousness ≥ 19.9 (OR 2.54, 95% CI 0.84–7.6, P = 0.09) and AOI ≥ 137°^ (OR 6.8, 95% CI 1.55–29.8, P = 0.011) were independent predictors of FPE. The optimal cut off derived using Youden’s index was 6.5. The area under the curve of a score predictive of FPE success was 0.816 (0.728–0.904, P < 0.001). In a validation cohort (n = 30), sensitivity, specificity, positive and negative predictive value of a score of 6–10 were 72.7%, 73.6%, 61.5% and 82.3%.
Conclusions
Clot imaging predicts the likelihood of achieving FPE in patients with MCA ELVO treated with the aspiration-first approach.</description><identifier>ISSN: 1591-0199</identifier><identifier>EISSN: 2385-2011</identifier><identifier>DOI: 10.1177/15910199211019174</identifier><identifier>PMID: 34000868</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Brain Ischemia - surgery ; Humans ; Infarction, Middle Cerebral Artery - diagnostic imaging ; Infarction, Middle Cerebral Artery - surgery ; Original ; Retrospective Studies ; Stroke - surgery ; Thrombectomy - methods ; Thrombosis ; Treatment Outcome</subject><ispartof>Interventional neuroradiology, 2022-04, Vol.28 (2), p.152-159</ispartof><rights>The Author(s) 2021</rights><rights>The Author(s) 2021 2021 SAGE Publications</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c456t-531caa379b7e663d676a9a1a1ba1fff34c4e28fa6d4f256dd9339f382a2b84dd3</cites><orcidid>0000-0002-5160-802X ; 0000-0003-4500-7954</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9131505/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9131505/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,21798,27901,27902,43597,43598,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34000868$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Waqas, Muhammad</creatorcontrib><creatorcontrib>Li, Weizhe</creatorcontrib><creatorcontrib>Patel, Tatsat R</creatorcontrib><creatorcontrib>Chin, Felix</creatorcontrib><creatorcontrib>Tutino, Vincent M</creatorcontrib><creatorcontrib>Dossani, Rimal H</creatorcontrib><creatorcontrib>Ren, Zeguang</creatorcontrib><creatorcontrib>Guerrero, Waldo R</creatorcontrib><creatorcontrib>Borlongan, Cesario V</creatorcontrib><creatorcontrib>Pressman, Elliot</creatorcontrib><creatorcontrib>Snyder, Kenneth</creatorcontrib><creatorcontrib>Davies, Jason M</creatorcontrib><creatorcontrib>Ley, Elad I</creatorcontrib><creatorcontrib>Ionita, Ciprian N</creatorcontrib><creatorcontrib>Siddiqui, Adnan H</creatorcontrib><creatorcontrib>Mokin, Maxim</creatorcontrib><title>Clot imaging characteristics predict first pass effect of aspiration—first approach to thrombectomy</title><title>Interventional neuroradiology</title><addtitle>Interv Neuroradiol</addtitle><description>Background
The value of clot imaging in patients with emergent large vessel occlusion (ELVO) treated with thrombectomy is unknown.
Methods
We performed retrospective analysis of clot imaging (clot density, perviousness, length, diameter, distance to the internal carotid artery (ICA) terminus and angle of interaction (AOI) between clot and the aspiration catheter) of consecutive cases of middle cerebral artery (MCA) occlusion and its association with first pass effect (FPE, TICI 2c-3 after a first attempt).
Results
Patients (n = 90 total) with FPE had shorter clot length (9.9 ± 4.5 mm vs. 11.7 ± 4.6 mm, P = 0.07), shorter distance from ICA terminus (11.0 ± 7.1 mm vs. 14.7 ± 9.8 mm, P = 0.048), higher perviousness (39.39 ± 29.5 vs 25.43 ± 17.6, P = 0.006) and larger AOI (153.6 ± 17.6 vs 140.3 ± 23.5, P = 0.004) compared to no-FPE patients. In multivariate analysis, distance from ICA terminus to clot ≤13.5 mm (odds ratio (OR) 11.05, 95% confidence interval (CI) 2.65–46.15, P = 0.001), clot length ≤9.9 mm (OR 7.34; 95% CI 1.8–29.96, P = 0.005), perviousness ≥ 19.9 (OR 2.54, 95% CI 0.84–7.6, P = 0.09) and AOI ≥ 137°^ (OR 6.8, 95% CI 1.55–29.8, P = 0.011) were independent predictors of FPE. The optimal cut off derived using Youden’s index was 6.5. The area under the curve of a score predictive of FPE success was 0.816 (0.728–0.904, P < 0.001). In a validation cohort (n = 30), sensitivity, specificity, positive and negative predictive value of a score of 6–10 were 72.7%, 73.6%, 61.5% and 82.3%.
Conclusions
Clot imaging predicts the likelihood of achieving FPE in patients with MCA ELVO treated with the aspiration-first approach.</description><subject>Brain Ischemia - surgery</subject><subject>Humans</subject><subject>Infarction, Middle Cerebral Artery - diagnostic imaging</subject><subject>Infarction, Middle Cerebral Artery - surgery</subject><subject>Original</subject><subject>Retrospective Studies</subject><subject>Stroke - surgery</subject><subject>Thrombectomy - methods</subject><subject>Thrombosis</subject><subject>Treatment Outcome</subject><issn>1591-0199</issn><issn>2385-2011</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc2KFDEQx4Mo7rj6AF4kRy-9ppJOOrkIMvgFC170HKrTyUyW7k6bZIS9-RA-oU9iN7MuiuCpoOpX__r4E_Ic2BVA170CaYCBMRy2AF37gOy40LLhDOAh2W31ZgMuyJNSbhhTUhh4TC5EyxjTSu-I34-p0jjhIc4H6o6Y0VWfY6nRFbpkP0RXaYi5VLpgKdSH4NdMChTLEjPWmOaf33-cCVyWnNAdaU20HnOa-pVN0-1T8ijgWPyzu3hJvrx7-3n_obn-9P7j_s1141qpaiMFOETRmb7zSolBdQoNAkKPEEIQrWs91wHV0AYu1TAYIUwQmiPvdTsM4pK8Pusup37yg_NzzTjaJa8H5lubMNq_K3M82kP6Zg0IkEyuAi_vBHL6evKl2ikW58cRZ59OxXLJtQbN-YbCGXU5lZJ9uB8DzG722H_sWXte_LnffcdvP1bg6gwUPHh7k055Xv_1H8VfcjmcMw</recordid><startdate>20220401</startdate><enddate>20220401</enddate><creator>Waqas, Muhammad</creator><creator>Li, Weizhe</creator><creator>Patel, Tatsat R</creator><creator>Chin, Felix</creator><creator>Tutino, Vincent M</creator><creator>Dossani, Rimal H</creator><creator>Ren, Zeguang</creator><creator>Guerrero, Waldo R</creator><creator>Borlongan, Cesario V</creator><creator>Pressman, Elliot</creator><creator>Snyder, Kenneth</creator><creator>Davies, Jason M</creator><creator>Ley, Elad I</creator><creator>Ionita, Ciprian N</creator><creator>Siddiqui, Adnan H</creator><creator>Mokin, Maxim</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-5160-802X</orcidid><orcidid>https://orcid.org/0000-0003-4500-7954</orcidid></search><sort><creationdate>20220401</creationdate><title>Clot imaging characteristics predict first pass effect of aspiration—first approach to thrombectomy</title><author>Waqas, Muhammad ; Li, Weizhe ; Patel, Tatsat R ; Chin, Felix ; Tutino, Vincent M ; Dossani, Rimal H ; Ren, Zeguang ; Guerrero, Waldo R ; Borlongan, Cesario V ; Pressman, Elliot ; Snyder, Kenneth ; Davies, Jason M ; Ley, Elad I ; Ionita, Ciprian N ; Siddiqui, Adnan H ; Mokin, Maxim</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c456t-531caa379b7e663d676a9a1a1ba1fff34c4e28fa6d4f256dd9339f382a2b84dd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Brain Ischemia - surgery</topic><topic>Humans</topic><topic>Infarction, Middle Cerebral Artery - diagnostic imaging</topic><topic>Infarction, Middle Cerebral Artery - surgery</topic><topic>Original</topic><topic>Retrospective Studies</topic><topic>Stroke - surgery</topic><topic>Thrombectomy - methods</topic><topic>Thrombosis</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Waqas, Muhammad</creatorcontrib><creatorcontrib>Li, Weizhe</creatorcontrib><creatorcontrib>Patel, Tatsat R</creatorcontrib><creatorcontrib>Chin, Felix</creatorcontrib><creatorcontrib>Tutino, Vincent M</creatorcontrib><creatorcontrib>Dossani, Rimal H</creatorcontrib><creatorcontrib>Ren, Zeguang</creatorcontrib><creatorcontrib>Guerrero, Waldo R</creatorcontrib><creatorcontrib>Borlongan, Cesario V</creatorcontrib><creatorcontrib>Pressman, Elliot</creatorcontrib><creatorcontrib>Snyder, Kenneth</creatorcontrib><creatorcontrib>Davies, Jason M</creatorcontrib><creatorcontrib>Ley, Elad I</creatorcontrib><creatorcontrib>Ionita, Ciprian N</creatorcontrib><creatorcontrib>Siddiqui, Adnan H</creatorcontrib><creatorcontrib>Mokin, Maxim</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Interventional neuroradiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Waqas, Muhammad</au><au>Li, Weizhe</au><au>Patel, Tatsat R</au><au>Chin, Felix</au><au>Tutino, Vincent M</au><au>Dossani, Rimal H</au><au>Ren, Zeguang</au><au>Guerrero, Waldo R</au><au>Borlongan, Cesario V</au><au>Pressman, Elliot</au><au>Snyder, Kenneth</au><au>Davies, Jason M</au><au>Ley, Elad I</au><au>Ionita, Ciprian N</au><au>Siddiqui, Adnan H</au><au>Mokin, Maxim</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clot imaging characteristics predict first pass effect of aspiration—first approach to thrombectomy</atitle><jtitle>Interventional neuroradiology</jtitle><addtitle>Interv Neuroradiol</addtitle><date>2022-04-01</date><risdate>2022</risdate><volume>28</volume><issue>2</issue><spage>152</spage><epage>159</epage><pages>152-159</pages><issn>1591-0199</issn><eissn>2385-2011</eissn><abstract>Background
The value of clot imaging in patients with emergent large vessel occlusion (ELVO) treated with thrombectomy is unknown.
Methods
We performed retrospective analysis of clot imaging (clot density, perviousness, length, diameter, distance to the internal carotid artery (ICA) terminus and angle of interaction (AOI) between clot and the aspiration catheter) of consecutive cases of middle cerebral artery (MCA) occlusion and its association with first pass effect (FPE, TICI 2c-3 after a first attempt).
Results
Patients (n = 90 total) with FPE had shorter clot length (9.9 ± 4.5 mm vs. 11.7 ± 4.6 mm, P = 0.07), shorter distance from ICA terminus (11.0 ± 7.1 mm vs. 14.7 ± 9.8 mm, P = 0.048), higher perviousness (39.39 ± 29.5 vs 25.43 ± 17.6, P = 0.006) and larger AOI (153.6 ± 17.6 vs 140.3 ± 23.5, P = 0.004) compared to no-FPE patients. In multivariate analysis, distance from ICA terminus to clot ≤13.5 mm (odds ratio (OR) 11.05, 95% confidence interval (CI) 2.65–46.15, P = 0.001), clot length ≤9.9 mm (OR 7.34; 95% CI 1.8–29.96, P = 0.005), perviousness ≥ 19.9 (OR 2.54, 95% CI 0.84–7.6, P = 0.09) and AOI ≥ 137°^ (OR 6.8, 95% CI 1.55–29.8, P = 0.011) were independent predictors of FPE. The optimal cut off derived using Youden’s index was 6.5. The area under the curve of a score predictive of FPE success was 0.816 (0.728–0.904, P < 0.001). In a validation cohort (n = 30), sensitivity, specificity, positive and negative predictive value of a score of 6–10 were 72.7%, 73.6%, 61.5% and 82.3%.
Conclusions
Clot imaging predicts the likelihood of achieving FPE in patients with MCA ELVO treated with the aspiration-first approach.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>34000868</pmid><doi>10.1177/15910199211019174</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-5160-802X</orcidid><orcidid>https://orcid.org/0000-0003-4500-7954</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Interventional neuroradiology, 2022-04, Vol.28 (2), p.152-159 |
| issn | 1591-0199 2385-2011 |
| language | eng |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; SAGE Complete; PubMed Central |
| subjects | Brain Ischemia - surgery Humans Infarction, Middle Cerebral Artery - diagnostic imaging Infarction, Middle Cerebral Artery - surgery Original Retrospective Studies Stroke - surgery Thrombectomy - methods Thrombosis Treatment Outcome |
| title | Clot imaging characteristics predict first pass effect of aspiration—first approach to thrombectomy |
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