Thrombus Length Predicts Lack of Post-Thrombolysis Early Recanalization in Minor Stroke With Large Vessel Occlusion.

Abstract

Background and Purpose- Whether bridging therapy, that is, intravenous thrombolysis [IVT] followed by mechanical thrombectomy, is beneficial as compared with IVT alone in minor stroke (National Institutes of Health Stroke Scale ≤5) with large vessel occlusion is unknown and should be tested in randomized trials. To help select the most appropriate candidates for such trials, we aimed to identify strong predictors of lack of post-IVT early recanalization (ER)-a surrogate marker of poor outcome. Methods- From a large multicenter French registry of patients with large vessel occlusion referred for thrombectomy immediately after IVT start between 2015 and 2017, we extracted 97 minor strokes with ER evaluated on first angiographic run or noninvasive imaging ≤3 hours from IVT start. Thrombus length was measured using the susceptibility vessel sign on T2* imaging. Results- Median National Institutes of Health Stroke Scale was 3 (interquartile range, 2-4), and occlusion sites were proximal (intracranial carotid or M1) and distal (M2) in 50% and 50% of patients, respectively. On pre-IVT MRI, median length of susceptibility vessel sign (visible in 90%) was 9.2 mm (interquartile range, 7.4-13.3). ER was present in 34% of patients, and susceptibility vessel sign length was the only clinical or radiological variable associated with no-ER after stepwise variable selection into a multivariable model (odds ratio, 1.53 per 1-mm increase; 95% CI, 1.21-1.92; P<0.001). The C statistic of susceptibility vessel sign length for no-ER prediction was 0.82 (95% CI, 0.73-0.92), and the optimal cutoff (Youden) was 9 mm. Sensitivity and specificity of this cutoff for no-ER were 67.8% (95% CI, 55.9-79.7) and 84.6% (95% CI, 70.7-98.5), respectively. Conclusions- ER was frequent in this cohort of IVT-treated minor stroke patients with large vessel occlusion considered for thrombectomy, and thrombus length was a powerful independent predictor of no-ER. These findings may help design randomized trials aiming to test bridging therapy versus IVT alone in this population.

• Authors: Pierre Seners, Julie Delepierre, Guillaume Turc, Hilde Henon, Michel Piotin, Caroline Arquizan, Tae-Hee Cho, Bertrand Lapergue, Jean-Philippe Cottier, Sébastien Richard, Laurence Legrand, Nicolas Bricout, Mikaël Mazighi, Cyril Dargazanli, Norbert Nighoghossian, Arturo Consoli, Séverine Debiais, Serge Bracard, Olivier Naggara, Xavier Leclerc, Michael Obadia, Vincent Costalat, Yves Berthezène, Marie Tisserand, Ana-Paula Narata, Benjamin Gory, Jean-Louis Mas, Catherine Oppenheim, Jean-Claude Baron, PREDICT-RECANAL Collaborators
• Journal: Stroke (Stroke) Vol. 50 Issue 3 Pg. 761-764 (03 2019) ISSN: 1524-4628 [Electronic] United States
• PMID: 30802186 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Aged, 80 and over
• Arterial Occlusive Diseases (diagnostic imaging, surgery, therapy)
• Cohort Studies
• Combined Modality Therapy
• Disease Susceptibility
• Female
• France
• Humans
• Male
• Middle Aged
• Predictive Value of Tests
• Sensitivity and Specificity
• Stroke (diagnostic imaging, surgery, therapy)
• Thrombectomy
• Thrombolytic Therapy
• Thrombosis (diagnostic imaging, therapy)
• Treatment Outcome