Abstract
IntroductionWe assessed the correlation between thrombus size before and after mechanical thrombectomy, measured as length by Computed Tomography Angiography/Non-Contrast Computed Tomography (CTA/NCCT) and Extracted Clot Area, ECA, respectively. We also assessed the influence of thrombus size on the number of passes required for clot removal and final recanalization outcome.Materials and methodsAcute ischaemic stroke (AIS) thrombi retrieved by mechanical thrombectomy from 500 patients and data of clot length by CTA/NCCT were collected from three hospitals in Europe. ECA was obtained by measuring the area of the extracted clot. Non-parametric tests were used for data analysis.ResultsA strong positive correlation was found between clot length on CTA/NCCT and ECA (rho = 0.619,N = 500,P < 0.0001*). Vessel size influences clot length on CTA/NCCT (H2 = 98.6, P < 0.0001*) and ECA (H2 = 105.6,P < 0.0001*), but the significant correlation between CTA/NCCT length and ECA was evident in all vessels. Poorer revascularisation outcome was associated with more passes (H5 = 73.1, P < 0.0001*). More passes were required to remove longer clots (CTA/NCCT; H4 = 31.4, P < 0.0001*; ECA; H4 = 50.2, P < 0.0001*). There was no significant main association between recanalization outcome and length on CTA/NCCT or ECA, but medium sized clots (ECA 20–40 mm2) were associated with least passes and highest revascularisation outcome (N = 500, X2 = 16.2, P < 0.0001*).ConclusionClot length on CTA/NCCT strongly correlates with ECA. Occlusion location influences clot size. More passes are associated with poorer revascularisation outcome and bigger clots. The relationship between size and revascularisation outcome is more complex. Clots of medium ECA take less passes to remove and are associated with better recanalization outcome than both smaller and larger clots.
Highlights
We assessed the correlation between thrombus size before and after mechanical thrombectomy, measured as length by Computed Tomography Angiography/Non-Contrast Computed Tomography (CTA/non-contrast computed tomography (NCCT)) and Extracted Clot Area, ECA, respectively
We found that the total number of passes required for clot removal was significantly associated with both clot length on Computed tomography angiography (CTA)/NCCT and ECA (Table 4)
The present study demonstrates the correlation between clot length on CTA/NCCT and area of extracted clot was slightly stronger for the cohort of patients that directly underwent mechanical thrombectomy compared to the patients pre-treated with rtPA
Summary
We assessed the correlation between thrombus size before and after mechanical thrombectomy, measured as length by Computed Tomography Angiography/Non-Contrast Computed Tomography (CTA/NCCT) and Extracted Clot Area, ECA, respectively. We assessed the influence of thrombus size on the number of passes required for clot removal and final recanalization outcome. We evaluated thrombus size both before and after mechanical thrombectomy to investigate the correlation between these two variables. We measured thrombus size before thrombectomy as clot length on CTA/NCCT, while for thrombus size evaluation after thrombectomy we introduced a new parameter that we called Extracted Clot Area, ECA, an assessment of the area of the retrieved clot. We interrogated the association between thrombus size and the number of passes and recanalization outcome, expressed as final mTICI score. We compared the findings in patients that were pre-treated with rtPA before mechanical thrombectomy and patients that underwent mechanical thrombectomy without thrombolysis, in order to assess the possible influence of rtPA
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