Skip to main content

Advertisement

SpringerLink
Log in

Effects of stroke etiology on angiographic success in patients undergoing mechanical thrombectomy

  • Original Article
  • Published:
Neurological Sciences Aims and scope Submit manuscript

Abstract

Objective

In this study, we investigated the relationship between stroke etiology and recanalization success with endovascular treatment in patients with acute ischemic stroke.

Material and methods

A total of 109 patients with anterior circulation stroke who underwent mechanical thrombectomy between August 2017 and June 2019 were included in the study retrospectively. Stroke etiologies of the patients were determined according to the TOAST criteria (Trial of Org 10,172 acute stroke treatment), and the relationship between stroke etiology and successful first-pass recanalization rate with endovascular treatment, total successful recanalization rate, and procedure time was evaluated.

Results

The data of 109 patients who presented with anterior circulation stroke and underwent mechanical thrombectomy were retrospectively analyzed. Fifty-five (50.5%) of the patients were female and 54 (49.5%) were male, and mean age was 67.3 ± 12.9. When the stroke etiologies of the patients were evaluated, it was found that 47 (43.1%) were due to large vessel ateherosclerotic disease (LVAD), and 62 (56.9%) were cardioembolic-related. Recanalization success and clinical outcomes did not differ significantly in patients with LVAD and those with cardioembolic etiology (p > 0.05). In addition, the number of patients with modified Rankin score (mRS) 6 in the atherosclerotic group was significantly higher than in the cardioembolic group (p = 0.022).

Conclusion

Recanalization success and clinical outcomes did not differ significantly in patients with LVAD and those with cardioembolic etiology. However, mortality rate was higher in patients with atherosclerotic etiology, due to the complexity of the procedure and the high rate of reocclusion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

The authors take full responsibility for the data, the analysis, and interpretation of the research, and they have full access to all of the data.

Abbreviations

TOAST:

Trial of Org 10,172 acute stroke treatment

LVAD:

Large vessel ateherosclerotic disease

mRS:

Modified Rankin score

References

  1. Kandregula S, Savardekar AR, Sharma P, McLarty J, Kosty J, Trosclair K et al (2021) Direct thrombectomy versus bridging thrombolysis with mechanical thrombectomy in middle cerebral artery stroke: a real-world analysis through National Inpatient Sample data. Neurosurg Focus 51(1):E4

    Article  Google Scholar 

  2. Fischer U, Kaesmacher J, S Plattner P, Bütikofer L, Mordasini P, Deppeler S et al (2021) SWIFT DIRECT: Solitaire™ With the Intention For Thrombectomy Plus Intravenous t PA Versus DIRECT Solitaire™ Stent-retriever Thrombectomy in Acute Anterior Circulation Stroke: Methodology of a randomized, controlled, multicentre study. Int J Stroke Oct 14:17474930211048768

  3. Hacke W (2018) A new DAWN for imaging-based selection in the treatment of acute stroke. N Engl J Med 378:81–83

    Article  Google Scholar 

  4. Albers GW, Marks MP, Kemp S, Christensen S, Tsai JP, Ortega-Gutierrez S et al (2018) Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 378:708–718

    Article  Google Scholar 

  5. Zaidat OO, Castonguay AC, Linfante I, Gupta R, Martin CO, Holloway WE et al (2018) First pass effect: a new measure for stroke thrombectomy devices. Stroke 49:660–666

    Article  Google Scholar 

  6. Seker F, Pfaff J, Wolf M, Ringleb PA, Nagel S, Schönenberger S et al (2017) Correlation of thrombectomy maneuver count with recanalization success and clinical outcome in patients with ischemic stroke. AJNR Am J Neuroradiol 38:1368–1371

    Article  CAS  Google Scholar 

  7. Spiotta AM, Vargas J, Turner R, Chaudry MI, Battenhouse H, Turk AS (2014) The golden hour of stroke intervention: effect of thrombectomy procedural time in acute ischemic stroke on outcome. J Neurointerv Surg 6:511–516

    Article  Google Scholar 

  8. Alawieh A, Pierce AK, Vargas J, Turk AS, Turner RD, Chaudry MI et al (2018) The golden 35 min of stroke intervention with ADAPT: effect of thrombectomy procedural time in acute ischemic stroke on outcome. J Neurointerv Surg 10:213–220

    Article  Google Scholar 

  9. Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J et al (1989) Measurements of acute cerebral infarction: a clinical examination scale. Stroke 20:864–870

    Article  CAS  Google Scholar 

  10. Barber PA, Demchuk AM, Zhang J, Buchan AM (2000) Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score. Lancet 355:1670–1674

    Article  CAS  Google Scholar 

  11. Newcommon NJ, Green TL, Haley E, Cooke T, Hill MD (2003) Improving the assessment of outcomes in stroke: use of a structured interview to assign grades on the modified Rankin Scale. Stroke 34:377–378

    Article  Google Scholar 

  12. Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC et al (2015) 2015 American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 46:3020–3035

    Article  CAS  Google Scholar 

  13. Zaidat OO, Yoo AJ, Khatri P, Tomsick TA, von Kummer R, Saver JL et al (2013) Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement. Stroke 44:2650–2663

    Article  Google Scholar 

  14. Hacke W, Kaste M, Fieschi C, Toni D, Lesaffre E, von Kummer R et al (1995) Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA 274:1017–1025

    Article  CAS  Google Scholar 

  15. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL et al (1993) Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 24:35–41

    Article  Google Scholar 

  16. Wahlgren N, Moreira T, Michel P, Steiner T, Jansen O, Cognard C et al (2016) Mechanical thrombectomy in acute ischemic stroke: consensus statement by ESO-Karolinska Stroke Update 2014/2015, supported by ESO, ESMINT, ESNR and EAN. Int J Stroke 11:134–147

    Article  Google Scholar 

  17. Ota T, Nishiyama Y, Koizumi S, Saito T, Ueda M, Saito N (2018) Impact of onset-to-groin puncture time within three hours on functional outcomes in mechanical thrombectomy for acute large-vessel occlusion. Interv Neuroradiol 24:162–167

    Article  Google Scholar 

  18. Ozdemir O, Giray S, Arlier Z, Baş DF, Inanc Y, Colak E (2015) Predictors of a good outcome after endovascular stroke treatment with stent retrievers. Sci World J 2015:403726

    Article  Google Scholar 

  19. Rha JH, Saver JL (2007) The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke 38:967–973

    Article  Google Scholar 

  20. Bai Y, Pu J, Wang H, Yang D, Hao Y, Xu H et al (2018) Impact of retriever passes on efficacy and safety outcomes of acute ischemic stroke treated with mechanical thrombectomy. Cardiovasc Intervent Radiol 41:1909–1916

    Article  Google Scholar 

  21. Shi ZS, Liebeskind DS, Xiang B, Ge SG, Feng L, Albers GW et al (2014) Predictors of functional dependence despite successful revascularization in large-vessel occlusion strokes. Stroke 45:1977–1984

    Article  Google Scholar 

  22. Kongbunkiat K, Wilson D, Kasemsap N, Tiamkao S, Jichi F, Palumbo V et al (2017) Leukoaraiosis, intracerebral hemorrhage, and functional outcome after acute stroke thrombolysis. Neurology 88:638–645

    Article  Google Scholar 

  23. Shi ZS, Loh Y, Liebeskind DS, Saver JL, Gonzalez NR, Tateshima S et al (2012) Leukoaraiosis predicts parenchymal hematoma after mechanical thrombectomy in acute ischemic stroke. Stroke 43:1806–1811

    Article  Google Scholar 

  24. Boeckh-Behrens T, Schubert M, Förschler A, Prothmann S, Kreiser K, Zimmer C et al (2016) The impact of histological clot composition in embolic stroke. Clin Neuroradiol 26:189–197

    Article  CAS  Google Scholar 

  25. Lee JS, Lee SJ, Yoo JS, Hong JH, Kim CH, Kim YW et al (2018) Prognosis of acute intracranial atherosclerosis-related occlusion after endovascular treatment. J Stroke 20:394–403

    Article  Google Scholar 

  26. Al Kasab S, Almadidy Z, Spiotta AM, Turk AS, Chaudry MI, Hungerford JP et al (2017) Endovascular treatment for AIS with underlying ICAD. J Neurointerv Surg 9:948–951

    Article  Google Scholar 

  27. Hwang YH, Kim YW, Kang DH, Kim YS, Liebeskind DS (2016) Impact of target arterial residual stenosis on outcome after endovascular revascularization. Stroke 47:1850–1857

    Article  Google Scholar 

  28. Tian C, Cao X, Wang J (2017) Recanalisation therapy in patients with acute ischaemic stroke caused by large artery occlusion: choice of therapeutic strategy according to underlying aetiological mechanism? Stroke Vasc Neurol 2(4):244–250

    Article  Google Scholar 

  29. Tsang ACO, Orru E, Klostranec JM, Yang IH, Lau KK, Tsang FCP et al (2019) Thrombectomy outcomes of intracranial atherosclerosis-related occlusions. Stroke 50(6):1460–1466

    Article  Google Scholar 

  30. Park H, Baek JH, Kim BM (2019) Endovascular treatment of acute stroke due to intracranial atherosclerotic stenosis-related large vessel occlusion. Front Neurol 2(10):308

    Article  Google Scholar 

  31. Malhotra K, Goyal N, Tsivgoulis G (2017) Internal carotid artery occlusion: pathophysiology, diagnosis, and management. Curr Atheroscler Rep 19(10):41

    Article  Google Scholar 

  32. Li X, Gu F, Ding J, Bian J, Wang N, Shu R et al (2020) The predictors and prognosis for unexpected reocclusion after mechanical thrombectomy: a meta-analysis. Ann Transl Med 8(23):1566

    Article  Google Scholar 

  33. Marto JP, Strambo D, Hajdu SD, Eskandari A, Nannoni S, Sirimarco G et al (2019) Twenty-four-hour reocclusion after successful mechanical thrombectomy: associated factors and long-term prognosis. Stroke 50(10):2960–2963

    Article  Google Scholar 

  34. Anadani M, Spiotta A, Alawieh A, Turjman F, Piotin M, Steglich-Arnholm H et al (2019) Effect of extracranial lesion severity on outcome of endovascular thrombectomy in patients with anterior circulation tandem occlusion: analysis of the TITAN registry. J Neurointerv Surg 11:970–974

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank Talip Asil who edited the English text.

Author information

Authors and Affiliations

  1. Department of Neurology, Tekirdag Namik Kemal University, Namik Kemal Kampus Cad No:1, Suleymanpasa, Tekirdag, 59030, Turkey

    Cigdem Deniz & Bengu Altunan

  2. Department of Neurology, Bezmialem Vakif University, Istanbul, Turkey

    Aslı Yaman Kula

  3. Department of Neurology, Memorial Hizmet Hospital, Istanbul, Turkey

    Talip Asil

Authors
  1. Cigdem Deniz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aslı Yaman Kula
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bengu Altunan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Talip Asil
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization: Cigdem Deniz, Talip Asil; data curation: Cigdem Deniz, Aslı Yaman Kula, Bengu Altunhan, Talip Asil; formal analysis and investigation: Cigdem Deniz, Bengu Altunhan, Aslı Yaman Kula, Talip Asil; methodology: Talip Asil, Cigdem Deniz; project administration: Cigdem Deniz, Aslı Yaman Kula, Talip Asil; resources: Cigdem Deniz, Bengu Altunhan, Aslı Yaman Kula, Talip Asil; supervision: Talip Asil; validation: Cigdem Deniz, Talip Asil, Bengu Altunhan; roles/writing—original draft: Cigdem Deniz; writing—review and editing; Cigdem Deniz, Talip Asil.

Corresponding author

Correspondence to Cigdem Deniz.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Ethical approval

Approval was obtained from the ethics committee of Bezmialem Vakıf University (10.9.2019–16/319). The procedures used in this study adhere to the tenets of the Declaration of Helsinki. All participants gave their written informed consent to participate in the study.

Informed consent statement

Informed consent statement was obtained from all participants.

Consent for publication

All authors agreed with this final version.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Talip Asil and Cigdem Deniz were working at the Memorial Hospital at the time of this study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Deniz, C., Kula, A.Y., Altunan, B. et al. Effects of stroke etiology on angiographic success in patients undergoing mechanical thrombectomy. Neurol Sci 43, 3737–3745 (2022). https://doi.org/10.1007/s10072-022-05892-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10072-022-05892-5

Keywords

Search

Navigation