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@article{2293056,
author = {Bala, Fouzi and Kappelhof, Manon and Ospel, Johanna M and Cimflová, Petra and Qiu, Wu and Singh, Nishita and Zhu, Kairan and Kim, Beom Joon and Wadhwa, Ankur and Almekhlafi, Mohammed A and Menon, Bijoy K and Nerea, Arrarte Terreros and Marquering, Henk and Majoie, Charles and Hill, Michael D and Goyal, Mayank},
article_location = {PHILADELPHIA},
article_number = {2},
doi = {http://dx.doi.org/10.1161/STROKEAHA.122.040542},
keywords = {angiography; catheters; ischemic stroke; thrombectomy; tomography},
language = {eng},
issn = {0039-2499},
journal = {Stroke},
title = {Distal Embolization in Relation to Radiological Thrombus Characteristics, Treatment Details, and Functional Outcome},
url = {https://www.ahajournals.org/doi/10.1161/STROKEAHA.122.040542},
volume = {54},
year = {2023}
}
TY - JOUR
ID - 2293056
AU - Bala, Fouzi - Kappelhof, Manon - Ospel, Johanna M - Cimflová, Petra - Qiu, Wu - Singh, Nishita - Zhu, Kairan - Kim, Beom Joon - Wadhwa, Ankur - Almekhlafi, Mohammed A - Menon, Bijoy K - Nerea, Arrarte Terreros - Marquering, Henk - Majoie, Charles - Hill, Michael D - Goyal, Mayank
PY - 2023
TI - Distal Embolization in Relation to Radiological Thrombus Characteristics, Treatment Details, and Functional Outcome
JF - Stroke
VL - 54
IS - 2
SP - 448-456
EP - 448-456
PB - Lippincott Williams & Wilkins
SN - 00392499
KW - angiography
KW - catheters
KW - ischemic stroke
KW - thrombectomy
KW - tomography
UR - https://www.ahajournals.org/doi/10.1161/STROKEAHA.122.040542
N2 - Background:Distal embolization (DE) is a common complication of endovascular treatment (EVT). We investigated the association of radiological thrombus characteristics and treatment details with DE. Methods:Patients with thin-slice (<= 2.5 mm) baseline noncontrast computed tomography and computed tomography angiography from the ESCAPE-NA1 trial (Efficacy and Safety of Nerinetide for the Treatment of Acute Ischemic Stroke) were included. Thrombus annotation was performed manually on coregistered scans by experienced readers. We assessed thrombus location, distance from internal carotid artery terminus, length, perviousness, absolute attenuation, and hyperdense artery sign. In addition, we evaluated balloon guide catheter use during EVT, first-line EVT approach, the number of thrombectomy passes, and prior intravenous thrombolysis administration. DE was defined as the occurrence of emboli distal to the target artery or in new territories during EVT. The association between thrombus characteristics, treatment details, and DE was evaluated using descriptive statistics and multivariable mixed-effects logistic regression, resulting in adjusted odds ratios (aOR) with 95% CI. Interaction between IVT and radiological thrombus characteristics was assessed by adding interaction terms in separate models. Results:In total, 496 out of 1105 (44.9%) ESCAPE-NA1 patients were included. DE was detected in 251 out of 496 patients (50.6%). Patients with DE had longer thrombi (median, 28.5 [interquartile range, 20.8-42.3] mm versus 24.4 [interquartile range, 17.1-32.4] mm; P<0.01). There were no statistically significant differences in the other thrombus characteristics. Factors associated with DE were thrombus length (aOR, 1.02 [95% CI, 1.01-1.04]), balloon guide catheter use (aOR, 0.49 [95% CI, 0.29-0.85]), and number of passes (aOR, 1.24 [95% CI, 1.04-1.47]). In patients with hyperdense artery sign, IVT was associated with reduced odds of DE (aOR, 0.55 [95% CI, 0.31-0.97]), P for interaction=0.04. Conclusions:DE was associated with longer thrombi, no balloon guide catheter use, and more EVT passes. IVT was associated with a reduced risk of DE in patients with hyperdense artery sign. These findings may support treatment decisions on IVT and EVT approaches.
ER -
BALA, Fouzi, Manon KAPPELHOF, Johanna M OSPEL, Petra CIMFLOVÁ, Wu QIU, Nishita SINGH, Kairan ZHU, Beom Joon KIM, Ankur WADHWA, Mohammed A ALMEKHLAFI, Bijoy K MENON, Arrarte Terreros NEREA, Henk MARQUERING, Charles MAJOIE, Michael D HILL and Mayank GOYAL. Distal Embolization in Relation to Radiological Thrombus Characteristics, Treatment Details, and Functional Outcome. \textit{Stroke}. PHILADELPHIA: Lippincott Williams \&{} Wilkins, 2023, vol.~54, No~2, p.~448-456. ISSN~0039-2499. Available from: https://dx.doi.org/10.1161/STROKEAHA.122.040542.
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