Correlation between acute ischaemic stroke clot length before mechanical thrombectomy and extracted clot area: Impact of thrombus size on number of passes for clot removal and final recanalization

Rosanna Rossi; Seán Fitzgerald; Sara M Gil; Oana M Mereuta; Andrew Douglas; Abhay Pandit; Paul Brennan; Sarah Power; Jack Alderson; Alan O'Hare; Michael Gilvarry; Ray McCarthy; Klearchos Psychogios; Georgios Magoufis; Georgios Tsivgoulis; István Szikora; Katarina Jood; Petra Redfors; Annika Nordanstig; Erik Ceder; Turgut Tatlisumak; Alexandros Rentzos; John Thornton; Karen M Doyle

doi:10.1177/23969873211024777

Correlation between acute ischaemic stroke clot length before mechanical thrombectomy and extracted clot area: Impact of thrombus size on number of passes for clot removal and final recanalization

Rosanna Rossi, Seán Fitzgerald, Sara M Gil, Oana M Mereuta, Andrew Douglas, Abhay Pandit, Paul Brennan, Sarah Power, Jack Alderson, Alan O'Hare, Michael Gilvarry, Ray McCarthy, Klearchos Psychogios, Georgios Magoufis, Georgios Tsivgoulis, István Szikora, Katarina Jood, Petra Redfors, Annika Nordanstig, Erik CederTurgut Tatlisumak, Alexandros Rentzos, John Thornton, Karen M Doyle

School of Medicine

Research output: Contribution to a Journal (Peer & Non Peer) › Article › peer-review

Abstract

INTRODUCTION: We assessed the correlation between thrombus size before and after mechanical thrombectomy, measured as length by Computed Tomography Angiography/Non-Contrast Computed Tomography (CTA/NCCT) and Extracted Clot Area, ECA, respectively. We also assessed the influence of thrombus size on the number of passes required for clot removal and final recanalization outcome.

MATERIALS AND METHODS: Acute ischaemic stroke (AIS) thrombi retrieved by mechanical thrombectomy from 500 patients and data of clot length by CTA/NCCT were collected from three hospitals in Europe. ECA was obtained by measuring the area of the extracted clot. Non-parametric tests were used for data analysis.

RESULTS: A strong positive correlation was found between clot length on CTA/NCCT and ECA (rho = 0.619,N = 500,P < 0.0001*). Vessel size influences clot length on CTA/NCCT (H2 = 98.6, P < 0.0001*) and ECA (H2 = 105.6,P < 0.0001*), but the significant correlation between CTA/NCCT length and ECA was evident in all vessels. Poorer revascularisation outcome was associated with more passes (H5 = 73.1, P < 0.0001*). More passes were required to remove longer clots (CTA/NCCT; H4 = 31.4, P < 0.0001*; ECA; H4 = 50.2, P < 0.0001*). There was no significant main association between recanalization outcome and length on CTA/NCCT or ECA, but medium sized clots (ECA 20-40 mm2) were associated with least passes and highest revascularisation outcome (N = 500, X2 = 16.2, P < 0.0001*).

CONCLUSION: Clot length on CTA/NCCT strongly correlates with ECA. Occlusion location influences clot size. More passes are associated with poorer revascularisation outcome and bigger clots. The relationship between size and revascularisation outcome is more complex. Clots of medium ECA take less passes to remove and are associated with better recanalization outcome than both smaller and larger clots.

Original language	English
Pages (from-to)	254-261
Number of pages	8
Journal	European Stroke Journal
Volume	6
Issue number	3
DOIs	https://doi.org/10.1177/23969873211024777
Publication status	Published - Sep 2021

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10.1177/23969873211024777

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Rossi, R., Fitzgerald, S., Gil, S. M., Mereuta, O. M., Douglas, A., Pandit, A., Brennan, P., Power, S., Alderson, J., O'Hare, A., Gilvarry, M., McCarthy, R., Psychogios, K., Magoufis, G., Tsivgoulis, G., Szikora, I., Jood, K., Redfors, P., Nordanstig, A., ... Doyle, K. M. (2021). Correlation between acute ischaemic stroke clot length before mechanical thrombectomy and extracted clot area: Impact of thrombus size on number of passes for clot removal and final recanalization. European Stroke Journal, 6(3), 254-261. https://doi.org/10.1177/23969873211024777

@article{deda7d0ae7924f7bbd5ff107e8df46a4,

title = "Correlation between acute ischaemic stroke clot length before mechanical thrombectomy and extracted clot area: Impact of thrombus size on number of passes for clot removal and final recanalization",

abstract = "INTRODUCTION: We assessed the correlation between thrombus size before and after mechanical thrombectomy, measured as length by Computed Tomography Angiography/Non-Contrast Computed Tomography (CTA/NCCT) and Extracted Clot Area, ECA, respectively. We also assessed the influence of thrombus size on the number of passes required for clot removal and final recanalization outcome.MATERIALS AND METHODS: Acute ischaemic stroke (AIS) thrombi retrieved by mechanical thrombectomy from 500 patients and data of clot length by CTA/NCCT were collected from three hospitals in Europe. ECA was obtained by measuring the area of the extracted clot. Non-parametric tests were used for data analysis.RESULTS: A strong positive correlation was found between clot length on CTA/NCCT and ECA (rho = 0.619,N = 500,P < 0.0001*). Vessel size influences clot length on CTA/NCCT (H2 = 98.6, P < 0.0001*) and ECA (H2 = 105.6,P < 0.0001*), but the significant correlation between CTA/NCCT length and ECA was evident in all vessels. Poorer revascularisation outcome was associated with more passes (H5 = 73.1, P < 0.0001*). More passes were required to remove longer clots (CTA/NCCT; H4 = 31.4, P < 0.0001*; ECA; H4 = 50.2, P < 0.0001*). There was no significant main association between recanalization outcome and length on CTA/NCCT or ECA, but medium sized clots (ECA 20-40 mm2) were associated with least passes and highest revascularisation outcome (N = 500, X2 = 16.2, P < 0.0001*).CONCLUSION: Clot length on CTA/NCCT strongly correlates with ECA. Occlusion location influences clot size. More passes are associated with poorer revascularisation outcome and bigger clots. The relationship between size and revascularisation outcome is more complex. Clots of medium ECA take less passes to remove and are associated with better recanalization outcome than both smaller and larger clots.",

author = "Rosanna Rossi and Se{\'a}n Fitzgerald and Gil, \{Sara M\} and Mereuta, \{Oana M\} and Andrew Douglas and Abhay Pandit and Paul Brennan and Sarah Power and Jack Alderson and Alan O'Hare and Michael Gilvarry and Ray McCarthy and Klearchos Psychogios and Georgios Magoufis and Georgios Tsivgoulis and Istv{\'a}n Szikora and Katarina Jood and Petra Redfors and Annika Nordanstig and Erik Ceder and Turgut Tatlisumak and Alexandros Rentzos and John Thornton and Doyle, \{Karen M\}",

note = "{\textcopyright} European Stroke Organisation 2021.",

year = "2021",

month = sep,

doi = "10.1177/23969873211024777",

language = "English",

volume = "6",

pages = "254--261",

journal = "European Stroke Journal",

issn = "2396-9873",

publisher = "SAGE Publications Inc.",

number = "3",

}

Rossi, R, Fitzgerald, S, Gil, SM, Mereuta, OM, Douglas, A , Pandit, A, Brennan, P, Power, S, Alderson, J, O'Hare, A, Gilvarry, M, McCarthy, R, Psychogios, K, Magoufis, G, Tsivgoulis, G, Szikora, I, Jood, K, Redfors, P, Nordanstig, A, Ceder, E, Tatlisumak, T, Rentzos, A, Thornton, J & Doyle, KM 2021, 'Correlation between acute ischaemic stroke clot length before mechanical thrombectomy and extracted clot area: Impact of thrombus size on number of passes for clot removal and final recanalization', European Stroke Journal, vol. 6, no. 3, pp. 254-261. https://doi.org/10.1177/23969873211024777

Correlation between acute ischaemic stroke clot length before mechanical thrombectomy and extracted clot area: Impact of thrombus size on number of passes for clot removal and final recanalization. / Rossi, Rosanna; Fitzgerald, Seán; Gil, Sara M et al.
In: European Stroke Journal, Vol. 6, No. 3, 09.2021, p. 254-261.

Research output: Contribution to a Journal (Peer & Non Peer) › Article › peer-review

TY - JOUR

T1 - Correlation between acute ischaemic stroke clot length before mechanical thrombectomy and extracted clot area

T2 - Impact of thrombus size on number of passes for clot removal and final recanalization

AU - Rossi, Rosanna

AU - Fitzgerald, Seán

AU - Gil, Sara M

AU - Mereuta, Oana M

AU - Douglas, Andrew

AU - Pandit, Abhay

AU - Brennan, Paul

AU - Power, Sarah

AU - Alderson, Jack

AU - O'Hare, Alan

AU - Gilvarry, Michael

AU - McCarthy, Ray

AU - Psychogios, Klearchos

AU - Magoufis, Georgios

AU - Tsivgoulis, Georgios

AU - Szikora, István

AU - Jood, Katarina

AU - Redfors, Petra

AU - Nordanstig, Annika

AU - Ceder, Erik

AU - Tatlisumak, Turgut

AU - Rentzos, Alexandros

AU - Thornton, John

AU - Doyle, Karen M

PY - 2021/9

Y1 - 2021/9

N2 - INTRODUCTION: We assessed the correlation between thrombus size before and after mechanical thrombectomy, measured as length by Computed Tomography Angiography/Non-Contrast Computed Tomography (CTA/NCCT) and Extracted Clot Area, ECA, respectively. We also assessed the influence of thrombus size on the number of passes required for clot removal and final recanalization outcome.MATERIALS AND METHODS: Acute ischaemic stroke (AIS) thrombi retrieved by mechanical thrombectomy from 500 patients and data of clot length by CTA/NCCT were collected from three hospitals in Europe. ECA was obtained by measuring the area of the extracted clot. Non-parametric tests were used for data analysis.RESULTS: A strong positive correlation was found between clot length on CTA/NCCT and ECA (rho = 0.619,N = 500,P < 0.0001*). Vessel size influences clot length on CTA/NCCT (H2 = 98.6, P < 0.0001*) and ECA (H2 = 105.6,P < 0.0001*), but the significant correlation between CTA/NCCT length and ECA was evident in all vessels. Poorer revascularisation outcome was associated with more passes (H5 = 73.1, P < 0.0001*). More passes were required to remove longer clots (CTA/NCCT; H4 = 31.4, P < 0.0001*; ECA; H4 = 50.2, P < 0.0001*). There was no significant main association between recanalization outcome and length on CTA/NCCT or ECA, but medium sized clots (ECA 20-40 mm2) were associated with least passes and highest revascularisation outcome (N = 500, X2 = 16.2, P < 0.0001*).CONCLUSION: Clot length on CTA/NCCT strongly correlates with ECA. Occlusion location influences clot size. More passes are associated with poorer revascularisation outcome and bigger clots. The relationship between size and revascularisation outcome is more complex. Clots of medium ECA take less passes to remove and are associated with better recanalization outcome than both smaller and larger clots.

AB - INTRODUCTION: We assessed the correlation between thrombus size before and after mechanical thrombectomy, measured as length by Computed Tomography Angiography/Non-Contrast Computed Tomography (CTA/NCCT) and Extracted Clot Area, ECA, respectively. We also assessed the influence of thrombus size on the number of passes required for clot removal and final recanalization outcome.MATERIALS AND METHODS: Acute ischaemic stroke (AIS) thrombi retrieved by mechanical thrombectomy from 500 patients and data of clot length by CTA/NCCT were collected from three hospitals in Europe. ECA was obtained by measuring the area of the extracted clot. Non-parametric tests were used for data analysis.RESULTS: A strong positive correlation was found between clot length on CTA/NCCT and ECA (rho = 0.619,N = 500,P < 0.0001*). Vessel size influences clot length on CTA/NCCT (H2 = 98.6, P < 0.0001*) and ECA (H2 = 105.6,P < 0.0001*), but the significant correlation between CTA/NCCT length and ECA was evident in all vessels. Poorer revascularisation outcome was associated with more passes (H5 = 73.1, P < 0.0001*). More passes were required to remove longer clots (CTA/NCCT; H4 = 31.4, P < 0.0001*; ECA; H4 = 50.2, P < 0.0001*). There was no significant main association between recanalization outcome and length on CTA/NCCT or ECA, but medium sized clots (ECA 20-40 mm2) were associated with least passes and highest revascularisation outcome (N = 500, X2 = 16.2, P < 0.0001*).CONCLUSION: Clot length on CTA/NCCT strongly correlates with ECA. Occlusion location influences clot size. More passes are associated with poorer revascularisation outcome and bigger clots. The relationship between size and revascularisation outcome is more complex. Clots of medium ECA take less passes to remove and are associated with better recanalization outcome than both smaller and larger clots.

U2 - 10.1177/23969873211024777

DO - 10.1177/23969873211024777

M3 - Article

C2 - 34746421

SN - 2396-9873

VL - 6

SP - 254

EP - 261

JO - European Stroke Journal

JF - European Stroke Journal

IS - 3

ER -

Correlation between acute ischaemic stroke clot length before mechanical thrombectomy and extracted clot area: Impact of thrombus size on number of passes for clot removal and final recanalization

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