1.Does Clot Burden Score on Baseline T2*-MRI Impact Clinical Outcome in Acute Ischemic Stroke Treated with Mechanical Thrombectomy?
Imad DERRAZ ; Romain BOURCIER ; Marc SOUDANT ; Sébastien SOIZE ; Wagih Ben HASSEN ; Gabriella HOSSU ; Frederic CLARENCON ; Anne Laure DERELLE ; Marie TISSERAND ; Helene RAOULT ; Laurence LEGRAND ; Serge BRACARD ; Catherine OPPENHEIM ; Olivier NAGGARA
Journal of Stroke 2019;21(1):91-100
BACKGROUND AND PURPOSE: A long clot, defined by a low (0-6) clot burden score (CBS) assessed by T2*-MR sequence, is associated with worse clinical outcome after intravenous thrombolysis (IVT) for acute ischemic stroke than is a small clot (CBS, 7-10). The added benefit of mechanical thrombectomy (MT) might be higher in patients with long clot. The aim of this pre-specified post hoc analysis of the THRombectomie des Artères CErebrales (THRACE) trial was to assess the association between T2*-CBS, successful recanalization and clinical outcome. METHODS: Of 414 patients randomized in the THRACE trial, 281 patients were included in this analysis. Associations between T2*-CBS and clinical outcome on the modified Rankin Scale (mRS) at 3 months were tested. RESULTS: High T2*-CBS, i.e., small clot, was associated with a shift toward better outcome on the mRS; proportional odds ratio (POR) per point CBS was 1.19 (95% confidence interval [CI], 1.05 to 1.34) in the whole population, 1.34 (95% CI, 1.13 to 1.59) in IVT group, and 1.04 (95% CI, 0.87 to 1.23) in IVTMT group. After adjustment for baseline prognostic variables, the effect of the full scale T2*-CBS was not statistically significant in the whole population and for the IVTMT group but remains significant for the IVT group (POR, 1.32; 95% CI, 1.11 to 1.58). CONCLUSIONS: A small clot, as assessed using T2*-CBS, is associated with improved outcome and may be used as a prognostic marker. Despite the worst outcome with long clot, the relative benefit of MT over IVT seemed to increase with low T2*-CBS and longer clot.
Humans
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Magnetic Resonance Imaging
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Odds Ratio
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Stroke
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Thrombectomy
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Thrombosis
2.Susceptibility Vessel Sign in the ASTER Trial: Higher Recanalization Rate and More Favourable Clinical Outcome after First Line Stent Retriever Compared to Contact Aspiration.
Romain BOURCIER ; Mickael MAZIGHI ; Julien LABREUCHE ; Robert FAHED ; Raphael BLANC ; Benjamin GORY ; Alain DUHAMEL ; Gaultier MARNAT ; Suzana SALEME ; Vincent COSTALAT ; Serge BRACARD ; Hubert DESAL ; Arturo CONSOLI ; Michel PIOTIN ; Bertrand LAPERGUE
Journal of Stroke 2018;20(2):268-276
BACKGROUND AND PURPOSE: In the Aspiration vs. Stent Retriever for Successful Revascularization (ASTER) trial, which evaluated contact aspiration (CA) versus stent retriever (SR) use as first-line technique, the impact of the susceptibility vessel sign (SVS) on magnetic resonance imaging (MRI) was studied to determine its influence on trial results. METHODS: We included patients having undergone CA or SR for M1 or M2 occlusions, who were screened by MRI with T2* gradient recalled echo. Occlusions were classified as SVS (+) or SVS (–) in each randomization arm. Modified thrombolysis in cerebral infarction (mTICI) 2b, 2c, or 3 revascularization rates were recorded and clinical outcomes assessed by the overall distribution of modified Rankin scale (mRS) at 90 days. RESULTS: Among the 202 patients included, 143 patients were SVS (+) (70.8%; 95% confidence interval [CI], 64.5% to 77.1%). Overall, there was no difference in angiographic and clinical outcomes according to SVS status. However, compared to SR, CA achieved a lower mTICI 2c/3 rate in SVS (+) patients (risk ratio [RR] for CA vs. SR, 0.60; 95% CI, 0.51 to 0.71) but not in SVS (–) (RR, 1.11; 95% CI, 0.69 to 1.77; P for interaction=0.018). A significant heterogeneity in favor of superiority of first-line SR strategy in SVS (+) patients was also found regarding the overall mRS distribution (common odds ratio for CA vs. SR, 0.40 vs. 1.32; 95% CI, 0.21 to 0.74 in SVS (+) vs. 95% CI, 0.51 to 3.35 in SVS (–); P for interaction=0.038). CONCLUSIONS: As a first line strategy, SR achieved higher recanalization rates and a more favourable clinical outcome at 3 months compared to CA when MRI shows SVS within the thrombus.
Arm
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Cerebral Infarction
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Humans
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Magnetic Resonance Imaging
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Odds Ratio
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Population Characteristics
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Random Allocation
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Stents*
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Thrombectomy
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Thrombosis
3.Erratum: Susceptibility Vessel Sign in the ASTER Trial: Higher Recanalization Rate and More Favourable Clinical Outcome after First Line Stent Retriever Compared to Contact Aspiration.
Romain BOURCIER ; Mickael MAZIGHI ; Julien LABREUCHE ; Robert FAHED ; Raphael BLANC ; Benjamin GORY ; Alain DUHAMEL ; Gaultier MARNAT ; Suzana SALEME ; Vincent COSTALAT ; Serge BRACARD ; Hubert DESAL ; Arturo CONSOLI ; Michel PIOTIN ; Bertrand LAPERGUE
Journal of Stroke 2018;20(3):416-416
On page 271, in Table 1, the value ‘1115 (65??51)’ of subgroup ‘Imaging to groin puncture’ and column heading ‘SVS (??’ was input incorrectly. The correct value is ‘115 (65??51).’
4.Recanalization before Thrombectomy in Tenecteplase vs. Alteplase-Treated Drip-and-Ship Patients
Pierre SENERS ; Jildaz CAROFF ; Nicolas CHAUSSON ; Guillaume TURC ; Christian DENIER ; Michel PIOTIN ; Manvel AGHASARYAN ; Cosmin ALECU ; Olivier CHASSIN ; Bertrand LAPERGUE ; Olivier NAGGARA ; Marc FERRIGNO ; Caroline ARQUIZAN ; Tae Hee CHO ; Ana Paula NARATA ; Sébastien RICHARD ; Nicolas BRICOUT ; Mikaël MAZIGHI ; Vincent COSTALAT ; Benjamin GORY ; Séverine DEBIAIS ; Arturo CONSOLI ; Serge BRACARD ; Catherine OPPENHEIM ; Jean Louis MAS ; Didier SMADJA ; Laurent SPELLE ; Jean Claude BARON
Journal of Stroke 2019;21(1):105-107
No abstract available.
Humans
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Thrombectomy