PMID- 28202431
OWN - NLM
STAT- MEDLINE
DCOM- 20180222
LR  - 20231112
IS  - 2047-9980 (Electronic)
IS  - 2047-9980 (Linking)
VI  - 6
IP  - 2
DP  - 2017 Feb 15
TI  - Thrombus Migration in the Middle Cerebral Artery: Incidence, Imaging Signs, and 
      Impact on Success of Endovascular Thrombectomy.
LID - 10.1161/JAHA.116.005149 [doi]
LID - e005149
AB  - BACKGROUND: Thrombus migration (TM) in intracranial vessels during ischemic 
      stroke has been reported in the form of case reports, but its incidence, impact 
      on the technical success of subsequent endovascular thrombectomy and patients' 
      outcome have never been studied systematically. METHODS AND RESULTS: 
      Retrospective analysis was done of 409 patients with isolated middle cerebral 
      artery occlusions treated with endovascular thrombectomy. TM was observed (1) by 
      analyzing discrepancies between computed tomographic angiography and digital 
      subtraction angiography and (2) by comparing infarct pattern in the 
      striatocapsular region with exact, angiographically assessed thrombus location 
      within the M1-segment and the involvement of the middle cerebral artery 
      perforators. Preinterventional infarction of discrepant regions (infarction in 
      regions supplied by more proximal vessels than those occluded by the clot) was 
      ensured by carefully reviewing available preinterventional multimodal imaging. 
      Adequate imaging inclusion criteria were met by 325 patients. Ninety-seven 
      patients showed signs of TM (26 with direct evidence, 71 with indirect evidence). 
      There was no difference in the frequency of preinterventional intravenous 
      recombinant tissue plasminogen activator administration between patients with TM 
      and those without (63.9% vs 64.9%, P=0.899). TM was associated with lower rates 
      of complete reperfusion (Thrombolysis in Cerebral Infarction score 3) (adjusted 
      odds ratio 0.400, 95% CI 0.226-0.707). Subsequently, preinterventional TM was 
      associated with lower rates of substantial neurologic improvement (adjusted odds 
      ratio 0.541, 95% CI 0.309-0.946). CONCLUSIONS: Preinterventional TM does not seem 
      to be facilitated by intravenous recombinant tissue plasminogen activator and 
      often occurs spontaneously. However, TM is associated with the risk of incomplete 
      reperfusion in subsequent thrombectomy, suggesting increased clot fragility. 
      Occurrence of TM may thereby have a substantial impact on the outcome of 
      endovascularly treated stroke patients.
CI  - (c) 2017 The Authors. Published on behalf of the American Heart Association, Inc., 
      by Wiley Blackwell.
FAU - Kaesmacher, Johannes
AU  - Kaesmacher J
AD  - Department of Neuroradiology, Klinikum rechts der Isar, TU Munchen, Munich, 
      Germany j.kaesmacher@tum.de.
FAU - Maegerlein, Christian
AU  - Maegerlein C
AD  - Department of Neuroradiology, Klinikum rechts der Isar, TU Munchen, Munich, 
      Germany.
FAU - Kaesmacher, Mirjam
AU  - Kaesmacher M
AD  - Department of Neuroradiology, Klinikum rechts der Isar, TU Munchen, Munich, 
      Germany.
FAU - Zimmer, Claus
AU  - Zimmer C
AD  - Department of Neuroradiology, Klinikum rechts der Isar, TU Munchen, Munich, 
      Germany.
FAU - Poppert, Holger
AU  - Poppert H
AD  - Department of Neurology, Klinikum rechts der Isar, TU Munchen, Munich, Germany.
FAU - Friedrich, Benjamin
AU  - Friedrich B
AD  - Department of Neuroradiology, Klinikum rechts der Isar, TU Munchen, Munich, 
      Germany.
FAU - Boeckh-Behrens, Tobias
AU  - Boeckh-Behrens T
AD  - Department of Neuroradiology, Klinikum rechts der Isar, TU Munchen, Munich, 
      Germany.
FAU - Kleine, Justus F
AU  - Kleine JF
AD  - Department of Neuroradiology, Klinikum rechts der Isar, TU Munchen, Munich, 
      Germany.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20170215
PL  - England
TA  - J Am Heart Assoc
JT  - Journal of the American Heart Association
JID - 101580524
SB  - IM
MH  - Aged
MH  - Angiography, Digital Subtraction/*methods
MH  - Brain Ischemia/diagnosis/epidemiology/*etiology
MH  - Computed Tomography Angiography/*methods
MH  - Endovascular Procedures/*methods
MH  - Female
MH  - Follow-Up Studies
MH  - Germany/epidemiology
MH  - Humans
MH  - Incidence
MH  - Infarction, Middle Cerebral Artery/diagnosis/epidemiology/*etiology
MH  - Male
MH  - Odds Ratio
MH  - Retrospective Studies
MH  - Thrombectomy/*methods
MH  - Thrombosis/*complications/diagnosis/surgery
MH  - Treatment Outcome
PMC - PMC5523786
OTO - NOTNLM
OT  - embolic stroke
OT  - endovascular recanalization
OT  - ischemic stroke
OT  - thrombectomy
OT  - thrombus
OT  - thrombus migration
EDAT- 2017/02/17 06:00
MHDA- 2018/02/23 06:00
PMCR- 2017/02/01
CRDT- 2017/02/17 06:00
PHST- 2017/02/17 06:00 [entrez]
PHST- 2017/02/17 06:00 [pubmed]
PHST- 2018/02/23 06:00 [medline]
PHST- 2017/02/01 00:00 [pmc-release]
AID - JAHA.116.005149 [pii]
AID - JAH32055 [pii]
AID - 10.1161/JAHA.116.005149 [doi]
PST - epublish
SO  - J Am Heart Assoc. 2017 Feb 15;6(2):e005149. doi: 10.1161/JAHA.116.005149.