Influence of Onset to Imaging Time on Radiological Thrombus Characteristics in Acute Ischemic Stroke

the MR CLEAN Registry Investigators

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Abstract

Introduction: Radiological thrombus characteristics are associated with patient outcomes and treatment success after acute ischemic stroke. These characteristics could be expected to undergo time-dependent changes due to factors influencing thrombus architecture like blood stasis, clot contraction, and natural thrombolysis. We investigated whether stroke onset-to-imaging time was associated with thrombus length, perviousness, and density in the MR CLEAN Registry population. Methods: We included 245 patients with M1-segment occlusions and thin-slice baseline CT imaging from the MR CLEAN Registry, a nation-wide multicenter registry of patients who underwent endovascular treatment for acute ischemic stroke within 6.5 h of onset in the Netherlands. We used multivariable linear regression to investigate the effect of stroke onset-to-imaging time (per 5 min) on thrombus length (in mm), perviousness and density (both in Hounsfield Units). In the first model, we adjusted for age, sex, intravenous thrombolysis, antiplatelet use, and history of atrial fibrillation. In a second model, we additionally adjusted for observed vs. non-observed stroke onset, CT-angiography collateral score, direct presentation at a thrombectomy-capable center vs. transfer, and stroke etiology. We performed exploratory subgroup analyses for intravenous thrombolysis administration, observed vs. non-observed stroke onset, direct presentation vs. transfer, and stroke etiology. Results: Median stroke onset-to-imaging time was 83 (interquartile range 53–141) min. Onset to imaging time was not associated with thrombus length nor perviousness (β 0.002; 95% CI −0.004 to 0.007 and β −0.002; 95% CI −0.015 to 0.011 per 5 min, respectively) and was weakly associated with thrombus density in the fully adjusted model (adjusted β 0.100; 95% CI 0.005–0.196 HU per 5 min). The subgroup analyses showed no heterogeneity of these findings in any of the subgroups, except for a significantly positive relation between onset-to-imaging time and thrombus density in patients transferred from a primary stroke center (adjusted β 0.18; 95% CI 0.022–0.35). Conclusion: In our population of acute ischemic stroke patients, we found no clear association between onset-to-imaging time and radiological thrombus characteristics. This suggests that elapsed time from stroke onset plays a limited role in the interpretation of radiological thrombus characteristics and their effect on treatment results, at least in the early time window.

Original languageEnglish
Article number693427
JournalFrontiers in Neurology
Volume12
DOIs
Publication statusPublished - 18 Jun 2021

Bibliographical note

Funding Information:
The MR CLEAN Registry was funded and carried out by the Erasmus University Medical Center, Amsterdam University Medical, and Maastricht University Medical Center. The Registry was additionally funded by the Applied Scientific Institute for Neuromodulation (TWIN). ITEA3—Medolution: Project Number 14003.

Funding Information:
Conflict of Interest: Erasmus MC received funds from Stryker by AL. Amsterdam UMC received funds from Stryker for consultations by CM and YR. MUMC received funds from Stryker and Codman for consultations by WZ. CM reports grants from the TWIN Foundation, the CVON/Dutch Heart Foundation, the European Commission. HM is cofounder and shareholder of Nico.lab. CM, MC, and YR own stock in Nico.lab.

Publisher Copyright:
© Copyright © 2021 Tolhuisen, Kappelhof, Dutra, Jansen, Guglielmi, Dippel, van Zwam, van Oostenbrugge, van der Lugt, Roos, Majoie, Caan, Marquering and the MR CLEAN Registry Investigators.

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