Feature | Thrombectomy Devices | September 02, 2015

Larger Thrombi Retrieval Associated with Improved Neurological Recovery After Stroke

Sub-study of MR CLEAN trial suggests that retrieving larger thrombi may be better than retrieving large numbers of smaller particles
 

acute ischemic stroke, larger thrombi retrieval, improved neurological recovery, ESC 2015, MR CLEAN trial, sub-study

September 2, 2015 — Retrieval of larger thrombi during intra-arterial treatment (IAT) is associated with improved neurological recovery after acute ischemic stroke, according to a sub-study of the MR CLEAN trial. Results of the sub-study were presented at the European Society of Cardiology (ESC) Congress 2015 by Anouchska Autar, Ph.D. candidate at the Erasmus Medical Centre in Rotterdam, the Netherlands.

“Acute ischemic strokes occur when a blood clot, also called a thrombus, embolizes to the brain where it restricts the flow of blood,” said Autar. “MR CLEAN was the first trial to show the benefit of IAT to remove blood clots within six hours after a stroke. IAT, which was given against a background of standard care including intravenous tissue plasminogen activator if indicated, led to better restoration of blood flow and improved functional outcome when compared to no IAT.”

Thrombi retrieved during the MR CLEAN trial were collected for the current sub-study to investigate the relationship between the macroscopic appearance of thrombi retrieved during IAT, cause of stroke and clinical outcome. Measures of macroscopic appearance included length, width, area and numbers of particles the thrombus had broken into.

Neurological recovery was assessed using the National Institutes of Health Stroke Severity Scale (NIHSS).

The study included 35 collections of thrombi from 35 patients who had undergone IAT after an acute ischemic stroke. Most of the patients had a severe stroke, of which 49 percent were of cardiac origin and 20 percent were due to atherosclerosis.

The researchers found that patients whose stroke was caused by atherosclerosis had significantly longer and larger thrombi (p=0.0035 and p=0.045, respectively) than those with stroke from other causes. “This could be because patients with atherosclerosis have more diseased arteries and this may influence thrombus size,” said Autar.

They also found that patients from whom longer and wider thrombi were retrieved had significantly improved neurological recovery at discharge after IAT compared to those with smaller thrombi (p=0.03 and p=0.04, respectively). “This finding is particularly important because it indicates that the larger the pieces that you retrieve, the better this is for your patient,” said Autar.

Interestingly, an increased number of particles retrieved during IAT showed a trend towards a worse neurological recovery at discharge, although the association was not significant (p=0.079). Autar said: “Together, this suggests that some emboli are more likely to disintegrate and the smaller particles may embolize and obstruct the microvasculature of the brain, leading to incomplete recovery.”

She concluded: “Our study shows that retrieval of larger thrombi during IAT is associated with improved neurological recovery at discharge in patients with acute ischemic stroke. The findings indicate that a simple parameter such as thrombus size might influence the decision to give or refrain from additional thrombolysis. This needs to be verified of course in larger trials.”

For more information: http://www.escardio.org/

Related Content

Gallery | Cath Lab | October 31, 2019
This is a photo essay of the interventional cardiology and structural heart technologies on the expo floor and discus
The Alphenix Aero Package from Canon Medical Systems USA, Inc. enables OBLs and ASCs to attain premium technology at a flexible price point by tailoring Canon Medical’s Alphenix systems to fit their facilities’ needs.

The Alphenix Aero Package from Canon Medical Systems USA, Inc. enables OBLs and ASCs to attain premium technology at a flexible price point by tailoring Canon Medical’s Alphenix systems to fit their facilities’ needs.

Technology | Cath Lab | October 28, 2019
Office based labs (OBLs) and ambulatory surgery centers (ASCs) require a fresh perspective from imaging vendors.
Marco Costa, M.D., Ph.D., MBA, president, UH Harrington Heart and Vascular Institute, performing a cath lab procedure.

Marco Costa, M.D., Ph.D., MBA, president, UH Harrington Heart and Vascular Institute, performing a cath lab procedure.

News | Cath Lab | October 28, 2019
October 28, 2019 — Leaders within University Hospitals and the Harrington Heart and Vascular Institute had a vision t
OmniVision Announces Guinness World Record for Smallest Image Sensor

OmniVision's OVM6948 CameraCubeChip, a fully packaged, wafer-level camera module measuring 0.65mm x 0.65mm x 1.158mm, built on OmniVision's OV6948, winner of the Guinness World Record for “The Smallest Image Sensor Commercially Available.”

News | Cath Lab | October 22, 2019
October 22, 2019 — OmniVision Technologies Inc.
People watch the presentation of the five-year EXCEL Trial data by Gregg Stone, M.D., live in the Abbott booth at TCT 2019. Abbott makes the Xience stent used in the trial, which compared equally with long term surgical outcomes. #TCT2019

People watch the live presentation of the five-year EXCEL Trial data by Gregg Stone, M.D., in the Abbott booth at TCT 2019. Abbott makes the Xience stent used in the trial, which compared equally with long-term CABG surgical outcomes. 

Feature | Cath Lab | October 03, 2019
October 3, 2019 – Five-year data from the EXCEL Trial showed patients with left main coronary disease treated with pe
Two Stents Implanted in Democratic Presidential Candidate Bernie Sanders, suffers chest pain
News | Cath Lab | October 02, 2019 | Dave Fornell, Editor
October 2, 2019 — Democratic presidential candidate Sen.
Bypass Surgery and Coronary Stenting Yield Comparable 10-Year Survival
News | Cath Lab | September 25, 2019
Ten-year survival rates are similar for bypass surgery and coronary stenting with drug-eluting stents in randomized...
Complete Revascularization Superior to Culprit Lesion-only Intervention
News | Cath Lab | September 10, 2019
An international randomized trial has shown that complete revascularization reduces major cardiovascular events...
The cath lab staff UH Portage Medical Center.

The cath lab staff UH Portage Medical Center.

Feature | Cath Lab | September 09, 2019 | Anjan Gupta, M.D., FACC, FSCAI
Primary percutaneous coronary intervention (PCI) is the preferred treatment for acute...
Overlay Init