Abstract
This retrospective study investigated whether the volume or density of the thrombus is predictive of recanalization in stent retriever (SR) treatment. Consecutive patients treated with SR thrombectomy as the first endovascular modality were enrolled. The thrombus volume and density were measured on thin-section noncontrast computed tomography using 3-dimensional software. The patients were grouped by recanalization status and the number of SR passes. Among 165 patients, recanalization was achieved with the first pass in 68 (50.0%), 2–3 passes in 43 (31.6%), and ≥4 passes in 25 (18.4%) patients. The thrombus volume was smaller in patients with (107.5 mm3) than without (173.7 mm3, p = 0.025) recanalization, and tended to be larger with increasing number of passes (p for trend = 0.001). The thrombus volume was an independent predictor of first-pass recanalization (odds ratio 0.93 per 10 mm3, 95% confidence interval 0.89–0.97). However, the thrombus density was not associated with recanalization success. Recanalization within 3 passes was associated with a favorable outcome. In conclusion, the thrombus volume was significantly related to recanalization in SR thrombectomy. Measuring the thrombus volume was particularly predictive of first-pass recanalization, which was associated with a higher likelihood of a favorable outcome.
Highlights
Thrombectomy with a stent retriever (SR) is recommended as a first-line endovascular treatment, with the highest level of evidence[1,2]
This study aimed to investigate whether the volume or density of the thrombus measured on thin-section noncontrast computed tomography (NCCT) is predictive of recanalization after intra-arterial recanalization therapy (IART) with an SR
Of 288 patients who received IART during the study period, 211 patients were treated with SR thrombectomy as the first endovascular modality (Fig. 1)
Summary
Thrombectomy with a stent retriever (SR) is recommended as a first-line endovascular treatment, with the highest level of evidence[1,2]. The chance of futile recanalization increases with the number of passes. Responses to recanalization treatment may differ according to the characteristics of the thrombus, such as volume and physical properties. A small thrombus may be retrieved with an SR, requiring only a few passes and yielding a greater chance of a favorable outcome. Few studies have investigated the association between thrombus characteristics and recanalization in view of the number of passes[5,6]. This study aimed to investigate whether the volume or density of the thrombus measured on thin-section NCCT is predictive of recanalization after intra-arterial recanalization therapy (IART) with an SR. We investigated whether there is an association between the volume or density of the thrombus and the number of SR passes to achieve recanalization
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