Thrombus Migration and Fragmentation After Intravenous Alteplase Treatment
| Autor: | Josep Puig, Jean-Martin Boulanger, James Evans, Seong Hwan Ahn, MacKenzie Horn, Michael D. Hill, Albert Y. Jin, Ana I. Calleja Sanz, Andrew M. Demchuk, Negar Asdaghi, Mohamed Najm, Mohammed A. Almekhlafi, Tomoyuki Ohara, Sung Il Sohn, Fahad S. Al-Ajlan, Talip Asil, Mayank Goyal, Thalia S. Field, Abdulaziz S. Al-Sultan, for INTERRSeCT Study Investigators, Bijoy K Menon, Robert Mikulik, Federica Letteri, Alexandre Y Poppe, Sadanand Dey, Dar Dowlatshahi |
|---|---|
| Přispěvatelé: | ASİL, Talip |
| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Computed Tomography Angiography 030204 cardiovascular system & hematology Ohara T. Menon B. K. Al-Ajlan F. S. Horn M. Najm M. Al-Sultan A. Puig J. Dowlatshahi D. Sanz A. I. C. Sohn S. et al. -Thrombus Migration and Fragmentation After Intravenous Alteplase Treatment The INTERRSeCT Study- STROKE cilt.52 ss.203-212 2021 03 medical and health sciences 0302 clinical medicine Fibrinolytic Agents Internal medicine medicine Humans Carotid Stenosis Thrombolytic Therapy cardiovascular diseases Thrombus Aged Aged 80 and over Advanced and Specialized Nursing business.industry Infarction Middle Cerebral Artery Middle Aged medicine.disease 3. Good health Stroke Treatment Outcome Tissue Plasminogen Activator Reperfusion cardiovascular system Cardiology Administration Intravenous Female Neurology (clinical) Intracranial Thrombosis Tomography X-Ray Computed Cardiology and Cardiovascular Medicine business Carotid Artery Internal 030217 neurology & neurosurgery |
| Zdroj: | Stroke. 52:203-212 |
| ISSN: | 1524-4628 0039-2499 |
| DOI: | 10.1161/strokeaha.120.029292 |
| Popis: | Background and Purpose: There is interest in what happens over time to the thrombus after intravenous alteplase. We study the effect of alteplase on thrombus structure and its impact on clinical outcome in patients with acute stroke. Methods: Intravenous alteplase treated stroke patients with intracranial internal carotid artery or middle cerebral artery occlusion identified on baseline computed tomography angiography and with follow-up vascular imaging (computed tomography angiography or first run of angiography before endovascular therapy) were enrolled from INTERRSeCT study (Identifying New Approaches to Optimize Thrombus Characterization for Predicting Early Recanalization and Reperfusion With IV Alteplase and Other Treatments Using Serial CT Angiography). Thrombus movement after intravenous alteplase was classified into complete recanalization, thrombus migration, thrombus fragmentation, and no change. Thrombus migration was diagnosed when occlusion site moved distally and graded according to degrees of thrombus movement (grade 0–3). Thrombus fragmentation was diagnosed when a new distal occlusion in addition to the primary occlusion was identified on follow-up imaging. The association between thrombus movement and clinical outcome was also evaluated. Results: Among 427 patients in this study, thrombus movement was seen in 54% with a median time of 123 minutes from alteplase administration to follow-up imaging, and sub-classified as marked (thrombus migration grade 2–3 + complete recanalization; 27%) and mild to moderate thrombus movement (thrombus fragmentation + thrombus migration grade 0–1; 27%). In patients with proximal M1/internal carotid artery occlusion, marked thrombus movement was associated with a higher rate of good outcome (90-day modified Rankin Scale, 0–2) compared with mild to moderate movement (52% versus 27%; adjusted odds ratio, 5.64 [95% CI, 1.72–20.10]). No difference was seen in outcomes between mild to moderate thrombus movement and no change. In M1 distal/M2 occlusion, marked thrombus movement was associated with improved 90-day good outcome compared with no change (70% versus 56%; adjusted odds ratio, 2.54 [95% CI, 1.21–5.51]). Conclusions: Early thrombus movement is common after intravenous alteplase. Marked thrombus migration leads to good clinical outcomes. Thrombus dynamics over time should be further evaluated in clinical trials of acute reperfusion therapy. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|