Guenego Adrien, Fahed Robert, Sussman Eric S, Leipzig Matthew, Albers Gregory W, Martin Blake W, Marcellus David G, Kuraitis Gabriella, Marks Michael P, Lansberg Maarten G, Wintermark Max, Heit Jeremy J
Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Stanford, CA, United States.
Division of Neurology, Department of Medicine, Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
Front Neurol. 2021 Feb 1;12:642877. doi: 10.3389/fneur.2021.642877. eCollection 2021.
The susceptibility-vessel-sign (SVS) allows thrombus visualization, length estimation and composition, and it may impact reperfusion during mechanical thrombectomy (MT). SVS can also describe thrombus shape in the occluded artery: in the straight M1-segment (S-shaped), or in an angulated/traversing a bifurcation segment (A-shaped). We determined whether SVS clot shape influenced reperfusion and outcomes after MT for proximal middle-cerebral-artery (M1) occlusions. Between May 2015 and March 2018, consecutive patients who underwent MT at one comprehensive stroke center and who had a baseline MRI with a T2 sequence were included. Clinical, procedural and radiographic data, including clot shape on SVS [angulated/bifurcation (A-SVS) vs. straight (S-SVS)] and length were assessed. Primary outcome was successful reperfusion (TICI 2b-3). Secondary outcome were MT complication rates, MT reperfusion time, and clinical outcome at 90-days. Predictors of outcome were assessed with univariate and multivariate analyses. A total of 62 patients were included. 56% (35/62) had an A-SVS. Clots were significantly longer in the A-SVS group (19 mm vs. 8 mm = 0.0002). Groups were otherwise well-matched with regard to baseline characteristics. There was a significantly lower rate of successful reperfusion in the A-SVS cohort (83%) compared to the S-SVS cohort (96%) in multivariable analysis [OR 0.04 (95% CI, 0.002-0.58), = 0.02]. There was no significant difference in long term clinical outcome between groups. Clot shape as determined on T2 imaging, in patients presenting with M1 occlusion appears to be a predictor of successful reperfusion after MT. Angulated and bifurcating clots are associated with poorer rates of successful reperfusion.
易感性血管征（SVS）可实现血栓可视化、长度估计及成分分析，并且可能会影响机械取栓术（MT）期间的再灌注情况。SVS还能描述闭塞动脉内血栓的形状：在M1段直线部分呈S形，或在成角/横跨分叉段呈A形。我们研究了SVS血栓形状是否会影响大脑中动脉近端（M1）闭塞患者MT后的再灌注及预后。2015年5月至2018年3月期间，纳入了在一家综合性卒中中心接受MT且有T2序列基线MRI检查的连续患者。评估了临床、手术及影像学数据，包括SVS上的血栓形状[成角/分叉（A-SVS）与直线（S-SVS）]及长度。主要结局为成功再灌注（脑梗死溶栓分级2b-3级）。次要结局为MT并发症发生率、MT再灌注时间及90天时的临床结局。通过单因素和多因素分析评估结局的预测因素。共纳入62例患者。56%（35/62）为A-SVS。A-SVS组的血栓明显更长（19 mm对8 mm，P = 0.0002）。两组在基线特征方面其他方面匹配良好。多因素分析显示，A-SVS队列的成功再灌注率（83%）显著低于S-SVS队列（96%）[比值比0.04（95%置信区间，0.002-0.58），P = 0.02]。两组之间长期临床结局无显著差异。对于M1闭塞患者，T2成像确定的血栓形状似乎是MT后成功再灌注的预测因素。成角和分叉血栓与较低的成功再灌注率相关。
