PMID- 36319085
OWN - NLM
STAT- MEDLINE
DCOM- 20231106
LR  - 20231117
IS  - 1759-8486 (Electronic)
IS  - 1759-8478 (Print)
IS  - 1759-8478 (Linking)
VI  - 15
IP  - e2
DP  - 2023 Nov
TI  - Thrombus migration in ischemic stroke due to large vessel occlusion: a question 
      of time.
PG  - e216-e222
LID - 10.1136/jnis-2022-019365 [doi]
AB  - BACKGROUND: Thrombus migration (TM) is frequently observed in large vessel 
      occlusion (LVO) ischemic stroke to be treated by endovascular thrombectomy (EVT). 
      TM may impede complete recanalization and hereby worsen clinical outcomes. This 
      study aimed to delineate factors associated with TM and clarify its impact on 
      technical and functional outcome. METHODS: All patients undergoing EVT due to LVO 
      in the anterior circulation at two tertiary stroke centers between October 2015 
      and December 2020 were included. Source imaging data of all individuals were 
      assessed regarding occurrence of TM by raters blinded to clinical data. Patient 
      data were gathered as part of the German Stroke Registry, a multicenter, 
      prospective registry assessing real-world outcomes. Technical outcome was 
      assessed by modified Thrombolysis in Cerebral Infarction scale (mTICI). 
      Functional outcome was assessed by modified Rankin Scale (mRS) at 3 months. 
      RESULTS: The study consisted of 512 individuals, of which 71 (13.8%) displayed 
      TM. In adjusted analyses, TM was associated with longer time from primary imaging 
      to reassessment in the angio suite (aOR 2.37 (1.47 to 3.84) per logarithmic step) 
      and intravenous thrombolysis (IVT; aOR 4.07 (2.17 to 7.65)). In individuals with 
      IVT, a needle-to-groin time >1 hour was associated with higher odds for TM (aOR 
      2.60 (1.20 to 5.99)). TM was associated with lack of complete recanalization 
      (aOR(mTICI3) 0.46 (0.24 to 0.90)) but TM did not worsen odds for good clinical 
      outcome (aOR(mRS</=2_d90) 0.89 (0.47 to 1.68)). CONCLUSIONS: TM is associated with 
      IVT and longer time between sequential assessments of thrombus location. 
      Consequently, TM may be of high relevance in patients with drip-and-ship 
      treatment.
CI  - (c) Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published 
      by BMJ.
FAU - Riegler, Christoph
AU  - Riegler C
AUID- ORCID: 0000-0002-2478-3500
AD  - Klinik und Hochschulambulanz fur Neurologie, Charite Universitatsmedizin Berlin, 
      Berlin, Germany christoph.riegler@charite.de.
AD  - Center for Stroke Research Berlin (CSB), Charite Universitatsmedizin Berlin, 
      Berlin, Germany.
FAU - Siebert, Eberhard
AU  - Siebert E
AUID- ORCID: 0000-0001-7395-6546
AD  - Institut fur Neuroradiologie, Charite Universitatsmedizin Berlin, Berlin, 
      Germany.
FAU - Kleine, Justus F
AU  - Kleine JF
AD  - Institut fur Neuroradiologie, Charite Universitatsmedizin Berlin, Berlin, 
      Germany.
FAU - Nolte, Christian H
AU  - Nolte CH
AUID- ORCID: 0000-0001-5577-1775
AD  - Klinik und Hochschulambulanz fur Neurologie, Charite Universitatsmedizin Berlin, 
      Berlin, Germany.
AD  - Center for Stroke Research Berlin (CSB), Charite Universitatsmedizin Berlin, 
      Berlin, Germany.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20221101
PL  - England
TA  - J Neurointerv Surg
JT  - Journal of neurointerventional surgery
JID - 101517079
RN  - 0 (Fibrinolytic Agents)
SB  - IM
MH  - Humans
MH  - Thrombolytic Therapy/methods
MH  - *Ischemic Stroke/diagnostic imaging/etiology/surgery
MH  - *Stroke/diagnostic imaging/etiology/surgery
MH  - Thrombectomy/methods
MH  - *Thrombosis/drug therapy
MH  - *Arterial Occlusive Diseases/drug therapy
MH  - Treatment Outcome
MH  - *Endovascular Procedures/methods
MH  - *Brain Ischemia/diagnostic imaging/etiology/surgery
MH  - Fibrinolytic Agents
PMC - PMC10646911
OTO - NOTNLM
OT  - Intervention
OT  - Stroke
OT  - Thrombectomy
OT  - Thrombolysis
COIS- Competing interests: CR received travel grants from ACTICOR Biotech outside the 
      submitted work. CHN received research grants from the German Ministry of Research 
      and Education, German Center for Neurodegenerative Diseases, German Center for 
      Cardiovascular Research, and speaker and/or consultation fees from Abbott, 
      Alexion, AstraZeneca, Bayer Pharma, Boehringer Ingelheim, Bristol-Myers Squibb, 
      Daiichi Sankyo, and Pfizer Pharma all outside the submitted work. JFK and ES 
      declare no conflicts of interest.
EDAT- 2022/11/02 06:00
MHDA- 2023/11/06 06:41
PMCR- 2023/11/15
CRDT- 2022/11/01 21:13
PHST- 2022/07/08 00:00 [received]
PHST- 2022/10/08 00:00 [accepted]
PHST- 2023/11/06 06:41 [medline]
PHST- 2022/11/02 06:00 [pubmed]
PHST- 2022/11/01 21:13 [entrez]
PHST- 2023/11/15 00:00 [pmc-release]
AID - jnis-2022-019365 [pii]
AID - 10.1136/jnis-2022-019365 [doi]
PST - ppublish
SO  - J Neurointerv Surg. 2023 Nov;15(e2):e216-e222. doi: 10.1136/jnis-2022-019365. 
      Epub 2022 Nov 1.