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A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
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Thrombus Migration Paradox in Patients With Acute Ischemic Stroke
Heitor C Alves1,2,3, Kilian M Treurniet1, Ivo G H Jansen1
1From the Departments of Radiology and Nuclear Medicine (H.C.A., K.M.T, I.G.H.J., B.G.D., G.Z., B.J.E., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands.
Stroke
|October 11, 2019
Summary
Thrombus location changes in acute ischemic stroke patients between imaging scans. Intravenous alteplase promotes thrombus migration and resolution, potentially improving outcomes but reducing reperfusion rates.
Area of Science:
- Neurology
- Interventional Radiology
- Stroke Medicine
Background:
- Thrombus location in acute ischemic stroke can shift between initial noninvasive imaging and angiography during endovascular treatment.
- Understanding thrombus dynamics is crucial for optimizing treatment strategies.
Purpose of the Study:
- To investigate the incidence of thrombus dynamics (growth, stability, migration, resolution) in acute ischemic stroke patients.
- To assess the impact of thrombus dynamics on patient outcomes and reperfusion.
- To determine the association between thrombus dynamics and the use of intravenous thrombolytics.
Main Methods:
- Analysis of 1349 patients from the MR CLEAN registry with target occlusions in the intracranial internal carotid artery, M1, or M2 segments.
- Classification of thrombus dynamics based on imaging during endovascular treatment.
- Evaluation of functional outcome at 90 days (modified Rankin Scale) and reperfusion success.
Main Results:
- Thrombus migration occurred in 22% of patients, growth in 6%, and resolution in 3%.
- Intravenous alteplase was linked to increased thrombus migration and resolution.
- Thrombus migration was associated with reduced rates of successful and complete reperfusion.
- In M1 occlusions, thrombus migration correlated with better functional outcomes.
Conclusions:
- Thrombus location frequently changes in acute ischemic stroke patients.
- Intravenous alteplase administration influences thrombus dynamics, increasing migration and resolution.
- While thrombus migration may improve functional outcomes, it can also decrease reperfusion rates.
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