Stent expansion and in-stent thrombus sign in the Trevo stent retriever predict recanalization and possible etiology during mechanical thrombectomy: A case series of 50 patients with acute middle cerebral artery occlusion.

Stent expansion and in-stent thrombus sign in the Trevo stent retriever predict recanalization and possible etiology during mechanical thrombectomy: A case series of 50 patients with acute middle cerebral artery occlusion.

World Neurosurg. 2018 Dec 28;:

Authors: Imahori T, Okamura Y, Sakata J, Shose H, Yokote A, Matsushima K, Matsui D, Kobayashi M, Hosoda K, Tanaka K, Fujita A, Kohmura E

Abstract
BACKGROUND: The interaction between the stent retriever and clot is a key factor for recanalization during mechanical thrombectomy.
OBJECTIVE: To evaluate the association between radiographically apparent features during thrombectomy and angiographic outcomes using the Trevo ProVue, which has a fully radiopaque strut.
METHODS: We retrospectively reviewed 50 patients with acute middle cerebral artery occlusion who were treated with the Trevo. Patients were divided into groups that achieved (1st-pass recanalization group, n=21) or did not achieve (non-1st-pass recanalization group, n=29) a modified Thrombolysis in Cerebral Ischemia score of 2b or 3 with the 1st-pass procedure. Patients were also divided into a thromboembolic (n=49) and atherosclerotic (n=11) group by occlusion etiology. We evaluated radiographic findings of the Trevo strut, e.g., degree of stent expansion and filling defect of the thrombus in the strut (in-stent thrombus sign) during the 1st-pass procedure among these groups.
RESULTS: The median stent expansion was significantly greater in the 1st-pass recanalization than non-1st-pass recanalization group (60% versus 34%; P<0.01), and in the thromboembolic than atherosclerotic group (45% versus 31%; P<0.01). The receiver operator characteristic curve shows moderate capacity of the prediction for recanalization and etiology, with an area under the curve of 0.83 and 0.73, respectively. The in-stent thrombus sign was significantly more common in the thromboembolic than atherosclerotic groups (86% versus 10%; P<0.01).
CONCLUSIONS: Greater stent expansion was associated with recanalization after thrombectomy. The in-stent thrombus sign may be useful for etiology prediction. These radiographic findings could provide useful real-time feedback during procedure, reflecting the clot-stent interaction.

PMID: 30597281 [PubMed - as supplied by publisher]

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