Background

The value of clot imaging in patients with emergent large vessel occlusion (ELVO) treated with thrombectomy is unknown.

Methods

We performed retrospective analysis of clot imaging (clot density, perviousness, length, diameter, distance to the internal carotid artery (ICA) terminus and angle of interaction (AOI) between clot and the aspiration catheter) of consecutive cases of middle cerebral artery (MCA) occlusion and its association with first pass effect (FPE, TICI 2c-3 after a first attempt).

Results

Patients (n = 90 total) with FPE had shorter clot length (9.9 ± 4.5 mm vs. 11.7 ± 4.6 mm, P = 0.07), shorter distance from ICA terminus (11.0 ± 7.1 mm vs. 14.7 ± 9.8 mm, P = 0.048), higher perviousness (39.39 ± 29.5 vs 25.43 ± 17.6, P = 0.006) and larger AOI (153.6 ± 17.6 vs 140.3 ± 23.5, P = 0.004) compared to no-FPE patients. In multivariate analysis, distance from ICA terminus to clot ≤13.5 mm (odds ratio (OR) 11.05, 95% confidence interval (CI) 2.65–46.15, P = 0.001), clot length ≤9.9 mm (OR 7.34; 95% CI 1.8–29.96, P = 0.005), perviousness ≥ 19.9 (OR 2.54, 95% CI 0.84–7.6, P = 0.09) and AOI ≥ 137°^ (OR 6.8, 95% CI 1.55–29.8, P = 0.011) were independent predictors of FPE. The optimal cut off derived using Youden’s index was 6.5. The area under the curve of a score predictive of FPE success was 0.816 (0.728–0.904, P < 0.001). In a validation cohort (n = 30), sensitivity, specificity, positive and negative predictive value of a score of 6–10 were 72.7%, 73.6%, 61.5% and 82.3%.

Conclusions

Clot imaging predicts the likelihood of achieving FPE in patients with MCA ELVO treated with the aspiration-first approach.

中文翻译：

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凝块成像特征预测抽吸的首过效应——血栓切除术的第一种方法

背景

凝块成像对接受血栓切除术治疗的急诊大血管闭塞 (ELVO) 患者的价值尚不清楚。

方法

我们对连续的大脑中动脉 (MCA) 病例进行了血块成像（血块密度、渗透性、长度、直径、距颈内动脉 (ICA) 末端的距离以及血块与抽吸导管之间的相互作用角 (AOI)）的回顾性分析) 闭塞及其与首过效应的关联（FPE，第一次尝试后的 TICI 2c-3）。

结果

患者（n = 90 总计）与 FPE 的血块长度较短（9.9 ± 4.5 毫米对 11.7 ± 4.6 毫米，P = 0.07），与 ICA 终点的距离较短（11.0 ± 7.1 毫米对 14.7 ± 9.8 毫米，P = 0.048），更高与无 FPE 患者相比，渗透性（39.39 ± 29.5 vs 25.43 ± 17.6，P = 0.006）和更大的 AOI（153.6 ± 17.6 vs 140.3 ± 23.5，P = 0.004）。在多变量分析中，从 ICA 末端到凝块的距离≤13.5 mm（比值比 (OR) 11.05，95% 置信区间 (CI) 2.65–46.15，P = 0.001），凝块长度≤9.9 mm（OR 7.34；95% CI 1.8 –29.96，P = 0.005），渗透率 ≥ 19.9（OR 2.54，95% CI 0.84-7.6，P = 0.09）和 AOI ≥ 137°^（OR 6.8，95% CI 1.55-29.8，P = 0.011）是独立预测因子FPE。使用 Youden 指数得出的最佳截止值为 6.5。预测 FPE 成功的分数曲线下面积为 0.816 (0.728–0.904, P < 0.001)。在验证队列中（n  = 30)，6-10 分的敏感性、特异性、阳性和阴性预测值分别为 72.7%、73.6%、61.5% 和 82.3%。

结论

凝块成像预测了采用抽吸优先方法治疗的 MCA ELVO 患者实现 FPE 的可能性。