Risks of Undersizing Stent Retriever Length Relative to Thrombus Length in Patients with Acute Ischemic Stroke.
Journal
AJNR. American journal of neuroradiology
ISSN: 1936-959X
Titre abrégé: AJNR Am J Neuroradiol
Pays: United States
ID NLM: 8003708
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
received:
14
04
2021
accepted:
30
07
2021
pubmed:
16
10
2021
medline:
3
3
2022
entrez:
15
10
2021
Statut:
ppublish
Résumé
Results regarding the association of thrombus length, stent retriever length, and recanalization success in patients with acute ischemic stroke are inconsistent. We hypothesized that the ratio of thrombus length to stent retriever length may be of particular relevance. Patients with acute ischemic stroke undergoing stent retriever thrombectomy at our institution between January 2010 and December 2018 were reviewed retrospectively. Thrombus length was assessed by measuring the susceptibility vessel sign on SWI using a 1.5T or 3T MR imaging scanner. Multivariable logistic regression models were used to determine the association between thrombus length, stent retriever length, and thrombus length/stent retriever length ratio with first-pass recanalization, overall recanalization, and embolization in new territories. Results are shown as adjusted ORs with 95% CIs. Additional mediation analyses were performed to test for indirect effects on first-pass recanalization and overall recanalization success. The main analysis included 418 patients (mean age, 74.9 years). Increasing stent retriever length was associated with first-pass recanalization. Decreasing thrombus length and lower thrombus length/stent retriever length ratios were associated with first-pass recanalization and overall recanalization. Thrombus length and stent retriever length showed no association with first-pass recanalization or overall recanalization once thrombus length/stent retriever length ratio was factored in, while thrombus length/stent retriever length ratio remained a significant factor in both models (adjusted OR, 0.316 [95% CI, 0.112-0.892]; Information about thrombus and stent length is more valuable when combined. High thrombus length/stent retriever length ratios, which may raise the risk of unsuccessful recanalization and embolization in new territories, should be avoided by adapting stent retriever selection to thrombus length whenever possible.
Sections du résumé
BACKGROUND AND PURPOSE
Results regarding the association of thrombus length, stent retriever length, and recanalization success in patients with acute ischemic stroke are inconsistent. We hypothesized that the ratio of thrombus length to stent retriever length may be of particular relevance.
MATERIALS AND METHODS
Patients with acute ischemic stroke undergoing stent retriever thrombectomy at our institution between January 2010 and December 2018 were reviewed retrospectively. Thrombus length was assessed by measuring the susceptibility vessel sign on SWI using a 1.5T or 3T MR imaging scanner. Multivariable logistic regression models were used to determine the association between thrombus length, stent retriever length, and thrombus length/stent retriever length ratio with first-pass recanalization, overall recanalization, and embolization in new territories. Results are shown as adjusted ORs with 95% CIs. Additional mediation analyses were performed to test for indirect effects on first-pass recanalization and overall recanalization success.
RESULTS
The main analysis included 418 patients (mean age, 74.9 years). Increasing stent retriever length was associated with first-pass recanalization. Decreasing thrombus length and lower thrombus length/stent retriever length ratios were associated with first-pass recanalization and overall recanalization. Thrombus length and stent retriever length showed no association with first-pass recanalization or overall recanalization once thrombus length/stent retriever length ratio was factored in, while thrombus length/stent retriever length ratio remained a significant factor in both models (adjusted OR, 0.316 [95% CI, 0.112-0.892];
CONCLUSIONS
Information about thrombus and stent length is more valuable when combined. High thrombus length/stent retriever length ratios, which may raise the risk of unsuccessful recanalization and embolization in new territories, should be avoided by adapting stent retriever selection to thrombus length whenever possible.
Identifiants
pubmed: 34649917
pii: ajnr.A7313
doi: 10.3174/ajnr.A7313
pmc: PMC8805752
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2181-2187Informations de copyright
© 2021 by American Journal of Neuroradiology.
Références
J Neurointerv Surg. 2017 Oct;9(10):937-939
pubmed: 27634955
Radiology. 2014 Oct;273(1):202-10
pubmed: 24895878
Stroke. 2019 Feb;50(2):441-447
pubmed: 30626287
J Neurointerv Surg. 2019 Jan;11(1):6-8
pubmed: 29858398
Stroke. 2011 Jun;42(6):1775-7
pubmed: 21474810
Eur Radiol. 2014 Aug;24(8):1735-41
pubmed: 24832928
Eur J Neurol. 2015 Jun;22(6):967-72
pubmed: 25786977
Stroke. 2017 Jun;48(6):1554-1559
pubmed: 28432264
Int J Stroke. 2014 Dec;9(8):980-4
pubmed: 25319168
Lancet. 1998 Oct 17;352(9136):1245-51
pubmed: 9788453
J Neurointerv Surg. 2016 Mar;8(3):295-9
pubmed: 25948592
AJNR Am J Neuroradiol. 2008 Feb;29(2):247-52
pubmed: 17974616
Sci Rep. 2017 Nov 21;7(1):15938
pubmed: 29162921
J Neurointerv Surg. 2019 May;11(5):433-438
pubmed: 30194109
AJNR Am J Neuroradiol. 2017 Aug;38(8):1586-1593
pubmed: 28596196
Neurology. 2020 Oct 27;95(17):e2331-e2342
pubmed: 32847948
Stroke. 2013 May;44(5):1396-401
pubmed: 23493730
Clin Neuroradiol. 2017 Sep;27(3):351-360
pubmed: 26795038
Interv Neurol. 2020 Jan;8(2-6):187-195
pubmed: 32508901
PLoS One. 2013 Oct 11;8(10):e76727
pubmed: 24146915
Neurosurgery. 2020 Apr 1;86(4):464-477
pubmed: 31313819
Radiology. 2016 Jul;280(1):169-76
pubmed: 26789499
J Stroke. 2019 Jan;21(1):91-100
pubmed: 30732444