RT Journal Article
SR Electronic
T1 Clot perviousness is associated with first pass success of aspiration thrombectomy in the COMPASS trial
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 509
OP 514
DO 10.1136/neurintsurg-2020-016434
VO 13
IS 6
A1 Maxim Mokin
A1 Muhammad Waqas
A1 Johanna Fifi
A1 Reade De Leacy
A1 David Fiorella
A1 Elad I Levy
A1 Kenneth Snyder
A1 Ricardo Hanel
A1 Keith Woodward
A1 Imran Chaudry
A1 Ansaar T Rai
A1 Donald Frei
A1 Josser E Delgado Almandoz
A1 Michael Kelly
A1 Adam S Arthur
A1 Blaise W Baxter
A1 Joey English
A1 Italo Linfante
A1 Kyle M Fargen
A1 Aquilla Turk
A1 Adnan H Siddiqui
A1 J Mocco
YR 2021
UL http://jnis.bmj.com/content/13/6/509.abstract
AB Background Clot density (Hounsfield units, HU) and perviousness (post-contrast increase in the HU of clot) are thought to be associated with clot composition. We evaluate whether these imaging characteristics were associated with angiographic outcomes of aspiration and stent retriever thrombectomy in COMPASS: a trial of aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion.Methods Clot density and perviousness were measured by two independent operators who were blind to all the final angiographic and clinical outcomes. The association of clot density and perviousness with the Thrombolysis In Cerebral Infarction (TICI) scale after first pass was assessed using univariate and multivariate analysis.Results Among all patients enrolled in COMPASS, 165 were eligible for the post-hoc analysis (81 patients in the aspiration first and 84 in the stent retriever first groups). Overall mean perviousness of clot was significantly higher in patient with mTICI 2b-3 after first pass (28.6±22.9 vs 20.3±19.2, p=0.017). Mean perviousness among patients who achieved TICI 2c/3 versus TICI 2b versus TICI 0-2a in the aspiration first group varied significantly (32.6±26.1, 35.3±24.4, and 17.7±13.1, p=0.013). The association of perviousness with first pass success was not significant in the stent retriever group. Using multivariate analysis, high perviousness (defined as cut-off >27.6) was an independent predictor of TICI 2b-3 (OR 3.82, 95% CI 1.10 to 13.19; p=0.034).Conclusions Clot perviousness is associated with first pass angiographic success in patients treated with the aspiration first approach for thrombectomy.Data are available upon reasonable request. Requests for data availability should be addressed to COMPASS principal investigators.