Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China; Graduate School of Peking Union Medical College, Beijing, China.
Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, Beijing, China.
J Stroke Cerebrovasc Dis. 2019 Oct;28(10):104311. doi: 10.1016/j.jstrokecerebrovasdis.2019.104311. Epub 2019 Jul 31.
Secondary embolism (SE) during mechanical thrombectomy (MT) for acute ischemic stroke (AIS) is the main reason for incomplete recanalization, while its risk factors are largely unknown. This study addresses a potential relationship between thrombus density on preinterventional computed tomography (CT) and the occurrence of SE.
We reviewed anterior circulation AIS patients who underwent MT from July 2015 to January 2019 in our center. Thrombus density was measured in Hounsfield Units (HU) on 1-mm and 5-mm preinterventional nonenhanced CT (NECT). Thrombus density, baseline characteristics, procedural, and clinical outcomes were compared between patients with SE and those without SE. Logistic regression was conducted to identified potential risk factors of SE.
Sixty-four consecutively patients were included, of whom SE was identified in 16 (25.0%) patients. Compared with those without SE, patients with SE showed a higher thrombus density on both 1-mm (72.85 versus 64.28, P = .005) and 5-mm NECT (60.31 versus 49.71, P < .001), a higher proportion of atrial fibrillation (75.0% versus 45.8%, P = .043), a lower clot burden score (.5 versus 6.0, P = .029), and a higher proportion of front-line contact aspiration strategy (50.0% versus 16.7%, P = .020). Multivariate regression analysis showed that only thrombus density was the independent predictor of SE (for the model including HU values on 1-mm NECT, OR 1.11, 95%CI 1.01-1.23, P = .029; for the model including HU values on 5-mm NECT, OR 1.09, 95%CI 1.02-1.17, P = .018).
Higher thrombus density was the independent predictor for SE. Further studies are needed to investigate its role in the optimization of thrombectomy strategy.
急性缺血性脑卒中（AIS）机械取栓（MT）过程中的继发性栓塞（SE）是不完全再通的主要原因，但其危险因素在很大程度上尚不清楚。本研究旨在探讨介入前计算机断层扫描（CT）上血栓密度与 SE 发生之间的潜在关系。
我们回顾了 2015 年 7 月至 2019 年 1 月期间在我中心接受 MT 的前循环 AIS 患者。在 1mm 和 5mm 介入前非增强 CT（NECT）上测量血栓密度，以亨氏单位（HU）表示。比较 SE 组与非 SE 组患者的血栓密度、基线特征、手术过程和临床结局。采用 Logistic 回归分析 SE 的潜在危险因素。
共纳入 64 例连续患者，其中 16 例（25.0%）发生 SE。与非 SE 组相比，SE 组在 1mm NECT（72.85 比 64.28，P=0.005）和 5mm NECT（60.31 比 49.71，P<0.001）上的血栓密度更高，心房颤动的比例更高（75.0%比 45.8%，P=0.043），血栓负荷评分较低（0.5 比 6.0，P=0.029），一线接触抽吸策略的比例较高（50.0%比 16.7%，P=0.020）。多变量回归分析显示，只有血栓密度是 SE 的独立预测因子（包括 1mmNECT 上 HU 值的模型，OR 1.11，95%CI 1.01-1.23，P=0.029；包括 5mmNECT 上 HU 值的模型，OR 1.09，95%CI 1.02-1.17，P=0.018）。
较高的血栓密度是 SE 的独立预测因子。需要进一步研究其在取栓策略优化中的作用。
