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Risk Factors for Distal Clot Migration during Mechanical Thrombectomy of Anterior Circulation Large Vessel Occlusion

Mahmoud H Mohammaden1,2, Christopher J Stapleton2, Denise Brunozzi2

  • 1Department of Neurology and Psychiatry, College of Medicine, South Valley University, Qena, Egypt.

Cerebrovascular Diseases (Basel, Switzerland)
|April 1, 2020
PubMed

Insights

Distal clot migration during mechanical thrombectomy for stroke is linked to poorer outcomes. Intravenous tissue plasminogen activator and short stentrievers predict this complication.

Area of Science:

  • Neurology
  • Interventional Radiology
  • Stroke Medicine

Background:

  • Distal clot migration (DCM) is a recognized complication of mechanical thrombectomy (MT).
  • Limited research exists on DCM's risk factors and impact on clinical outcomes in acute ischemic stroke patients.

Purpose of the Study:

  • To identify predictors of distal clot migration (DCM).
  • To evaluate the effect of DCM on functional outcomes following mechanical thrombectomy (MT).

Main Methods:

  • Retrospective review of 65 patients with anterior circulation large vessel occlusion (LVO) treated with MT.
  • Univariable and multivariable analyses to assess predictors of DCM and 90-day functional outcomes (modified Rankin Scale; mRS 0-2).

Main Results:

  • DCM occurred in 33.8% of patients.
  • Predictors of DCM included pre-procedural intravenous tissue plasminogen activator (IV-tPA) and stentrievers thrombectomy.
  • DCM was associated with lower recanalization rates (TICI 2b/3) and worse 90-day functional outcomes (mRS 0-2).
  • Short stentrievers (<40 mm) were linked to higher DCM risk in middle cerebral artery occlusions.

Conclusions:

  • Distal clot migration (DCM) in MT for anterior circulation LVO correlates with reduced recanalization and poorer 90-day functional outcomes.
  • Intravenous tissue plasminogen activator (IV-tPA) administration and MT using short stentrievers are independent predictors of DCM.
Abstract

Keywords:
Acute ischemic strokeDistal clot migrationIntravenous tissue plasminogen activatorLarge vessel occlusionMechanical thrombectomyStentrievers

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