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Benefit of mechanical thrombectomy in acute ischemic stroke related to calcified cerebral embolus
Téodor Grand1, Cyril Dargazanli2, Chrysanthi Papagiannaki3
1Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.
Purpose:
Mechanical thrombectomies (MT) in patients with large vessel occlusion (LVO) related to calcified cerebral embolus (CCE) have been reported, through small case series, being associated with low reperfusion rate and worse outcome, compared to regular MT. The purpose of the MASC (Mechanical Thrombectomy in Acute Ischemic Stroke Related to Calcified Cerebral Embolus) study was to evaluate the incidence of CCEs treated by MT and the effectiveness of MT in this indication.
Methods:
The MASC study is a retrospective multicentric (n = 37) national study gathering the cases of adult patients who underwent MT for acute ischemic stroke with LVO related to a CCE in France from January 2015 to November 2019. Reperfusion rate (mTICI ≥ 2B), complication rate and 90-day mRS were systematically collected. We then conducted a systematic review by searching for articles in PubMed, Cochrane Library, Embase and Google Scholar from January 2015 to March 2020. A meta-analysis was performed to estimate clinical outcome at 90 days, reperfusion rate and complications.
Results:
We gathered data from 35 patients. Reperfusion was obtained in 57% of the cases. Good clinical outcome was observed in 28% of the patients. The meta-analysis retrieved 136 patients. Reperfusion and good clinical outcome were obtained in 50% and 29% of the cases, respectively.
Conclusion:
The MASC study found worse angiographic and clinical outcomes compared to regular thrombectomies. Individual patient-based meta-analysis including the MASC findings shows a 50% reperfusion rate and a 29% of good clinical outcome.
Insights
Mechanical thrombectomy for acute ischemic stroke due to calcified cerebral embolus (CCE) shows lower reperfusion and clinical outcomes. The MASC study and meta-analysis confirm these challenges in treating CCEs with mechanical thrombectomy (MT).
Area of Science:
- Neurology
- Interventional Neuroradiology
- Stroke Medicine
Background:
- Large vessel occlusion (LVO) stroke treatment with mechanical thrombectomy (MT) is standard, but calcified cerebral embolus (CCE) presents unique challenges.
- Previous small case series suggest CCEs are associated with lower reperfusion rates and worse outcomes compared to non-calcified emboli.
Purpose of the Study:
- To evaluate the incidence of CCEs in patients undergoing MT for acute ischemic stroke.
- To assess the effectiveness of MT in treating LVO related to CCEs.
Main Methods:
- The MASC study is a retrospective, multicenter national study in France (Jan 2015-Nov 2019) including 37 centers.
- Data collected included reperfusion rates (mTICI ≥ 2B), complication rates, and 90-day modified Rankin Scale (mRS) scores.
- A systematic review and meta-analysis of relevant literature (Jan 2015-Mar 2020) were performed to complement the study findings.
Main Results:
- Data from 35 patients in the MASC study showed a 57% reperfusion rate and 28% good clinical outcome (90-day mRS).
- The meta-analysis, including 136 patients, reported a 50% reperfusion rate and a 29% good clinical outcome.
- These outcomes are generally worse compared to MT for non-calcified emboli.
Conclusions:
- Mechanical thrombectomy for acute ischemic stroke secondary to calcified cerebral embolus is associated with suboptimal angiographic and clinical outcomes.
- The findings highlight the need for further research into optimizing MT techniques or alternative strategies for CCEs.
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