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

Pierre Seners 1 Julie Delepierre 1 Guillaume Turc 1 Hilde Henon 2, 3 Michel Piotin 4 Caroline Arquizan 5 Tae-Hee Cho 6, 7 Bertrand Lapergue 8 Jean-Philippe Cottier 9 Sébastien Richard 10 Laurence Legrand 11 Nicolas Bricout 12 Mikael Mazighi 4, 13 Cyril Dargazanli 14 Norbert Nighoghossian 15 Arturo Consoli 8 Séverine Debiais 16 Serge Bracard 10 Olivier Naggara 17, 1 Xavier Leclerc 12 Michael Obadia 4 Vincent Costalat 18, 14 Yves Berthezène 19 Marie Tisserand 8 Ana-Paula Narata 20 Benjamin Gory 21 Jean-Louis Mas 22 Catherine Oppenheim 23 Jean-Claude Baron 1
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.
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Contributeur : Nathalie Salvy-Cordoba <>
Soumis le : lundi 29 juin 2020 - 11:15:06
Dernière modification le : lundi 26 avril 2021 - 16:40:03

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Pierre Seners, Julie Delepierre, Guillaume Turc, Hilde Henon, Michel Piotin, et al.. Thrombus Length Predicts Lack of Post-Thrombolysis Early Recanalization in Minor Stroke With Large Vessel Occlusion. Stroke, American Heart Association, 2019, 50 (3), pp.761-764. ⟨10.1161/STROKEAHA.118.023455⟩. ⟨hal-02883540⟩



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