Document Detail

Thrombus branching and vessel curvature are important determinants of middle cerebral artery trunk recanalization with Merci thrombectomy devices.
MedLine Citation:
PMID:  22282888     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: Determinants of successful recanalization likely differ for Merci thrombectomy and intra-arterial pharmacological fibrinolysis interventions. Although the amount of thrombotic material to be digested is an important consideration for chemical lysis, mechanical debulking may be more greatly influenced by other target lesion characteristics.
METHODS: In consecutive patients with acute ischemic stroke treated with Merci thrombectomy for middle cerebral artery M1 occlusions, we analyzed the influence on recanalization success and clinical outcome of target thrombus size (length) and shape (curvature and branching) on pretreatment T2* gradient echo MRI.
RESULTS: Among 65 patients, pretreatment MRI showed susceptibility vessel signs in 45 (69%). Thrombus length averaged 13.03 mm (range, 5.56-34.91) and irregular shape (curvature or branching) was present in 17 of 45 (38%). Presence and length of susceptibility vessel signs did not predict recanalization or good clinical outcome. Substantial recanalization (Thrombolysis In Cerebral Infarction 2b or 3) and good clinical outcome (modified Rankin Scale score ≤2) were more frequent with regular than irregular susceptibility vessel signs shape (57% versus 18%, P=0.013; 39% versus 6%, P=0.017). On multiple regression analysis, the only independent predictor of substantial recanalization was irregular susceptibility vessel signs (OR, 0.16; 95% CI, 0.04-0.69; P=0.014); and leading predictors of good clinical outcome were baseline National Institutes of Health Stroke Scale (OR, 1.20; 95% CI, 1.03-1.40; P= 0.019) and irregular susceptibility vessel signs (OR, 9.36; 95% CI, 0.98-89.4; P=0.052).
CONCLUSIONS: Extension of thrombus into middle cerebral artery division branches and curving shape of the middle cerebral artery stem, but not thrombus length, decrease technical and clinical success of Merci thrombectomy in M1 occlusions.
Liangfu Zhu; David S Liebeskind; Reza Jahan; Sidney Starkman; Noriko Salamon; Gary Duckwiler; Fernando Vinuela; Satoshi Tateshima; Nestor Gonzalez; Pablo Villablanca; Latisha K Ali; Doojin Kim; Bruce Ovbiagele; Michael Froehler; Matthew Tenser; Jeffrey L Saver
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-01-26
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  43     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-02-21     Completed Date:  2012-08-15     Revised Date:  2014-06-20    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  787-92     Citation Subset:  IM    
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MeSH Terms
Aged, 80 and over
Databases, Factual
Disease Susceptibility
Endovascular Procedures / methods*
Magnetic Resonance Imaging
Middle Aged
Middle Cerebral Artery / pathology*
Prospective Studies
Regression Analysis
Thrombectomy / instrumentation*,  methods
Thrombosis / pathology*
Treatment Outcome
Grant Support
P50 NS044378/NS/NINDS NIH HHS; P50 NS044378/NS/NINDS NIH HHS; P50 NS044378-07/NS/NINDS NIH HHS; P50 NS044378-08/NS/NINDS NIH HHS; P50 NS044378-09/NS/NINDS NIH HHS

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