Small thrombus size, thrombus composition, and poor collaterals predict pre-interventional thrombus migration
Standard
Small thrombus size, thrombus composition, and poor collaterals predict pre-interventional thrombus migration. / Sporns, Peter B; Krähling, Hermann; Psychogios, Marios N; Jeibmann, Astrid; Minnerup, Jens; Broocks, Gabriel; Meyer, Lukas; Brehm, Alex; Wildgruber, Moritz; Fiehler, Jens; Kniep, Helge; Hanning, Uta.
In: J NEUROINTERV SURG, Vol. 13, No. 5, 05.2021, p. 409-414.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Small thrombus size, thrombus composition, and poor collaterals predict pre-interventional thrombus migration
AU - Sporns, Peter B
AU - Krähling, Hermann
AU - Psychogios, Marios N
AU - Jeibmann, Astrid
AU - Minnerup, Jens
AU - Broocks, Gabriel
AU - Meyer, Lukas
AU - Brehm, Alex
AU - Wildgruber, Moritz
AU - Fiehler, Jens
AU - Kniep, Helge
AU - Hanning, Uta
N1 - © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2021/5
Y1 - 2021/5
N2 - BACKGROUND: Different imaging characteristics such as clot burden score, collaterals, and pre-interventional thrombus migration are associated with functional outcome in patients with acute ischemic stroke. Moreover, histological thrombus composition is associated with pre-interventional thrombus migration. We hypothesized that smaller clots may more likely migrate and that collateral status in ischemic stroke patients may mediate this tendency of the clot to migrate.METHODS: In this prospective cohort of consecutive ischemic stroke patients, clot burden scores and collateral scores were rated and the retrieved thrombi were histologically analyzed. We then investigated the relationship between clot burden score, probability for thrombus migration, and collateral scores using mediation analysis.RESULTS: 163 patients are included of which 36 (22.1%) had a clot migration. Probability of thrombus migration was significantly associated with lower collateral scores (P<0.01), higher clot burden scores (P<0.01), shorter thrombi (P<0.01), and higher RBC count (P<0.01). In the mediator pathway, higher collateral scores were significantly associated with higher clot burden scores (P<0.01) and younger age (P=0.029). The total effect of an increase in clot burden score by one grade on thrombus migration is composed of the direct effect (+18%, P<0.01) and the collateral score-mediated indirect effect (-5%, P<0.01).CONCLUSIONS: Smaller, erythrocyte-rich thrombi tend to migrate more often. Good collaterals seem to have a considerable effect on limiting migration. This supports the hypothesis that larger clots have stronger adherence with the vessel wall and that good collaterals increase the counter pressure distal of the clot.
AB - BACKGROUND: Different imaging characteristics such as clot burden score, collaterals, and pre-interventional thrombus migration are associated with functional outcome in patients with acute ischemic stroke. Moreover, histological thrombus composition is associated with pre-interventional thrombus migration. We hypothesized that smaller clots may more likely migrate and that collateral status in ischemic stroke patients may mediate this tendency of the clot to migrate.METHODS: In this prospective cohort of consecutive ischemic stroke patients, clot burden scores and collateral scores were rated and the retrieved thrombi were histologically analyzed. We then investigated the relationship between clot burden score, probability for thrombus migration, and collateral scores using mediation analysis.RESULTS: 163 patients are included of which 36 (22.1%) had a clot migration. Probability of thrombus migration was significantly associated with lower collateral scores (P<0.01), higher clot burden scores (P<0.01), shorter thrombi (P<0.01), and higher RBC count (P<0.01). In the mediator pathway, higher collateral scores were significantly associated with higher clot burden scores (P<0.01) and younger age (P=0.029). The total effect of an increase in clot burden score by one grade on thrombus migration is composed of the direct effect (+18%, P<0.01) and the collateral score-mediated indirect effect (-5%, P<0.01).CONCLUSIONS: Smaller, erythrocyte-rich thrombi tend to migrate more often. Good collaterals seem to have a considerable effect on limiting migration. This supports the hypothesis that larger clots have stronger adherence with the vessel wall and that good collaterals increase the counter pressure distal of the clot.
U2 - 10.1136/neurintsurg-2020-016228
DO - 10.1136/neurintsurg-2020-016228
M3 - SCORING: Journal article
C2 - 32690758
VL - 13
SP - 409
EP - 414
JO - J NEUROINTERV SURG
JF - J NEUROINTERV SURG
SN - 1759-8478
IS - 5
ER -
