Thrombus Migration and Fragmentation After Intravenous
Alteplase Treatment The INTERRSeCT Study

J 2021

Thrombus Migration and Fragmentation After Intravenous Alteplase Treatment The INTERRSeCT Study

OHARA, T., B. K. MENON, F. S. AL-AJLAN, M. HORN, M. NAJM et. al.

Základní údaje

Originální název

Thrombus Migration and Fragmentation After Intravenous Alteplase Treatment The INTERRSeCT Study

Autoři

OHARA, T., B. K. MENON, F. S. AL-AJLAN, M. HORN, M. NAJM, A. AL-SULTAN, J. PUIG, D. DOWLATSHAHI, A. I. C. SANZ, SI SOHN, S. H. AHN, A. Y. POPPE, Robert MIKULÍK (203 Česká republika, domácí), N. ASDAGHI, T. S. FIELD, A. JIN, T. ASIL, J. M. BOULANGER, F. LETTERI, S. DEY, J. W. EVANS, M. GOYAL, M. D. HILL, M. ALMEKHLAFI a A. M. DEMCHUK (garant)

Vydání

Stroke, Dallas, Lippincott Williams & Wilkins, 2021, 0039-2499

Další údaje

Jazyk

angličtina

Typ výsledku

Článek v odborném periodiku

Obor

30210 Clinical neurology

Stát vydavatele

Spojené státy

Utajení

není předmětem státního či obchodního tajemství

Odkazy

URL

Impakt faktor

Impact factor: 10.170

Kód RIV

RIV/00216224:14110/21:00121123

Organizační jednotka

Lékařská fakulta

DOI

http://dx.doi.org/10.1161/STROKEAHA.120.029292

UT WoS

000603081900056

Klíčová slova anglicky

angiography; computed tomography angiography; internal carotid artery; middle cerebral artery; reperfusion

Štítky

14110127, rivok

Příznaky

Mezinárodní význam, Recenzováno

Změněno: 11. 2. 2021 14:20, Mgr. Tereza Miškechová

Anotace

V originále

Background and Purpose: There is interest in what happens over time to the thrombus after intravenous alteplase. We study the effect of alteplase on thrombus structure and its impact on clinical outcome in patients with acute stroke. Methods: Intravenous alteplase treated stroke patients with intracranial internal carotid artery or middle cerebral artery occlusion identified on baseline computed tomography angiography and with follow-up vascular imaging (computed tomography angiography or first run of angiography before endovascular therapy) were enrolled from INTERRSeCT study (Identifying New Approaches to Optimize Thrombus Characterization for Predicting Early Recanalization and Reperfusion With IV Alteplase and Other Treatments Using Serial CT Angiography). Thrombus movement after intravenous alteplase was classified into complete recanalization, thrombus migration, thrombus fragmentation, and no change. Thrombus migration was diagnosed when occlusion site moved distally and graded according to degrees of thrombus movement (grade 0-3). Thrombus fragmentation was diagnosed when a new distal occlusion in addition to the primary occlusion was identified on follow-up imaging. The association between thrombus movement and clinical outcome was also evaluated. Results: Among 427 patients in this study, thrombus movement was seen in 54% with a median time of 123 minutes from alteplase administration to follow-up imaging, and sub-classified as marked (thrombus migration grade 2-3 + complete recanalization; 27%) and mild to moderate thrombus movement (thrombus fragmentation + thrombus migration grade 0-1; 27%). In patients with proximal M1/internal carotid artery occlusion, marked thrombus movement was associated with a higher rate of good outcome (90-day modified Rankin Scale, 0-2) compared with mild to moderate movement (52% versus 27%; adjusted odds ratio, 5.64 [95% CI, 1.72-20.10]). No difference was seen in outcomes between mild to moderate thrombus movement and no change. In M1 distal/M2 occlusion, marked thrombus movement was associated with improved 90-day good outcome compared with no change (70% versus 56%; adjusted odds ratio, 2.54 [95% CI, 1.21-5.51]). Conclusions: Early thrombus movement is common after intravenous alteplase. Marked thrombus migration leads to good clinical outcomes. Thrombus dynamics over time should be further evaluated in clinical trials of acute reperfusion therapy.

Citovat

OHARA, T., B. K. MENON, F. S. AL-AJLAN, M. HORN, M. NAJM, A. AL-SULTAN, J. PUIG, D. DOWLATSHAHI, A. I. C. SANZ, SI SOHN, S. H. AHN, A. Y. POPPE, Robert MIKULÍK, N. ASDAGHI, T. S. FIELD, A. JIN, T. ASIL, J. M. BOULANGER, F. LETTERI, S. DEY, J. W. EVANS, M. GOYAL, M. D. HILL, M. ALMEKHLAFI a A. M. DEMCHUK. Thrombus Migration and Fragmentation After Intravenous Alteplase Treatment The INTERRSeCT Study. Stroke. Dallas: Lippincott Williams & Wilkins, 2021, roč. 52, č. 1, s. 203-212. ISSN 0039-2499. Dostupné z: https://dx.doi.org/10.1161/STROKEAHA.120.029292.

@article{1740678,
   author = {Ohara, T. and Menon, B. K. and AlandAjlan, F. S. and Horn, M. and Najm, M. and AlandSultan, A. and Puig, J. and Dowlatshahi, D. and Sanz, A. I. C. and Sohn, SI and Ahn, S. H. and Poppe, A. Y. and Mikulík, Robert and Asdaghi, N. and Field, T. S. and Jin, A. and Asil, T. and Boulanger, J. M. and Letteri, F. and Dey, S. and Evans, J. W. and Goyal, M. and Hill, M. D. and Almekhlafi, M. and Demchuk, A. M.},
   article_location = {Dallas},
   article_number = {1},
   doi = {http://dx.doi.org/10.1161/STROKEAHA.120.029292},
   keywords = {angiography; computed tomography angiography; internal carotid artery; middle cerebral artery; reperfusion},
   language = {eng},
   issn = {0039-2499},
   journal = {Stroke},
   title = {Thrombus Migration and Fragmentation After Intravenous Alteplase Treatment The INTERRSeCT Study},
   url = {https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.120.029292},
   volume = {52},
   year = {2021}
}

TY  - JOUR
ID  - 1740678
AU  - Ohara, T. - Menon, B. K. - Al-Ajlan, F. S. - Horn, M. - Najm, M. - Al-Sultan, A. - Puig, J. - Dowlatshahi, D. - Sanz, A. I. C. - Sohn, SI - Ahn, S. H. - Poppe, A. Y. - Mikulík, Robert - Asdaghi, N. - Field, T. S. - Jin, A. - Asil, T. - Boulanger, J. M. - Letteri, F. - Dey, S. - Evans, J. W. - Goyal, M. - Hill, M. D. - Almekhlafi, M. - Demchuk, A. M.
PY  - 2021
TI  - Thrombus Migration and Fragmentation After Intravenous Alteplase Treatment The INTERRSeCT Study
JF  - Stroke
VL  - 52
IS  - 1
SP  - 203-212
EP  - 203-212
PB  - Lippincott Williams & Wilkins
SN  - 00392499
KW  - angiography
KW  - computed tomography angiography
KW  - internal carotid artery
KW  - middle cerebral artery
KW  - reperfusion
UR  - https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.120.029292
L2  - https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.120.029292
N2  - Background and Purpose: There is interest in what happens over time to the thrombus after intravenous alteplase. We study the effect of alteplase on thrombus structure and its impact on clinical outcome in patients with acute stroke. Methods: Intravenous alteplase treated stroke patients with intracranial internal carotid artery or middle cerebral artery occlusion identified on baseline computed tomography angiography and with follow-up vascular imaging (computed tomography angiography or first run of angiography before endovascular therapy) were enrolled from INTERRSeCT study (Identifying New Approaches to Optimize Thrombus Characterization for Predicting Early Recanalization and Reperfusion With IV Alteplase and Other Treatments Using Serial CT Angiography). Thrombus movement after intravenous alteplase was classified into complete recanalization, thrombus migration, thrombus fragmentation, and no change. Thrombus migration was diagnosed when occlusion site moved distally and graded according to degrees of thrombus movement (grade 0-3). Thrombus fragmentation was diagnosed when a new distal occlusion in addition to the primary occlusion was identified on follow-up imaging. The association between thrombus movement and clinical outcome was also evaluated. Results: Among 427 patients in this study, thrombus movement was seen in 54% with a median time of 123 minutes from alteplase administration to follow-up imaging, and sub-classified as marked (thrombus migration grade 2-3 + complete recanalization; 27%) and mild to moderate thrombus movement (thrombus fragmentation + thrombus migration grade 0-1; 27%). In patients with proximal M1/internal carotid artery occlusion, marked thrombus movement was associated with a higher rate of good outcome (90-day modified Rankin Scale, 0-2) compared with mild to moderate movement (52% versus 27%; adjusted odds ratio, 5.64 [95% CI, 1.72-20.10]). No difference was seen in outcomes between mild to moderate thrombus movement and no change. In M1 distal/M2 occlusion, marked thrombus movement was associated with improved 90-day good outcome compared with no change (70% versus 56%; adjusted odds ratio, 2.54 [95% CI, 1.21-5.51]). Conclusions: Early thrombus movement is common after intravenous alteplase. Marked thrombus migration leads to good clinical outcomes. Thrombus dynamics over time should be further evaluated in clinical trials of acute reperfusion therapy.
ER  -

OHARA, T., B. K. MENON, F. S. AL-AJLAN, M. HORN, M. NAJM, A. AL-SULTAN, J. PUIG, D. DOWLATSHAHI, A. I. C. SANZ, SI SOHN, S. H. AHN, A. Y. POPPE, Robert MIKULÍK, N. ASDAGHI, T. S. FIELD, A. JIN, T. ASIL, J. M. BOULANGER, F. LETTERI, S. DEY, J. W. EVANS, M. GOYAL, M. D. HILL, M. ALMEKHLAFI a A. M. DEMCHUK. Thrombus Migration and Fragmentation After Intravenous Alteplase Treatment The INTERRSeCT Study. \textit{Stroke}. Dallas: Lippincott Williams \&{} Wilkins, 2021, roč.~52, č.~1, s.~203-212. ISSN~0039-2499. Dostupné z: https://dx.doi.org/10.1161/STROKEAHA.120.029292.

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