Abstract
Background
Different imaging characteristics such as clot burden score,
collaterals, and pre-interventional thrombus migration are associated
with functional outcome in patients with acute ischemic stroke.
Moreover, histological thrombus composition is associated with
pre-interventional thrombus migration. We hypothesized that smaller
clots may more likely migrate and that collateral status in ischemic
stroke patients may mediate this tendency of the clot to
migrate.
Methods
In this prospective cohort of consecutive ischemic stroke patients,
clot burden scores and collateral scores were rated and the retrieved
thrombi were histologically analyzed. We then investigated the
relationship between clot burden score, probability for thrombus
migration, and collateral scores using mediation analysis.
Results
163 patients are included of which 36 (22.1%) had a clot migration.
Probability of thrombus migration was significantly associated with
lower collateral scores (P<0.01), higher clot burden scores
(P<0.01), shorter thrombi (P<0.01), and higher RBC count
(P<0.01). In the mediator pathway, higher collateral scores were
significantly associated with higher clot burden scores (P<0.01) and
younger age (P=0.029). The total effect of an increase in clot burden
score by one grade on thrombus migration is composed of the direct
effect (+18%, P<0.01) and the collateral score-mediated indirect
effect (−5%, P<0.01).
Conclusions
Smaller, erythrocyte-rich thrombi tend to migrate more often. Good
collaterals seem to have a considerable effect on limiting migration.
This supports the hypothesis that larger clots have stronger adherence
with the vessel wall and that good collaterals increase the counter
pressure distal of the clot.
Subject
Neurology (clinical),General Medicine,Surgery
Cited by
10 articles.
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