Thrombus location and length predictors of early neurological deterioration

A large retrospective observational study in patients with minor strokes with large vessel occlusion found that thrombus location and length are strong predictors of early neurological deterioration (END) [1]. This may help to select the best candidates for additional endovascular therapy.

Researchers from Paris, France conducted the multicentre observational study MINOR-STROKE in which they included 721 patients with intravenous thrombolysis-treated minor strokes (NIH Stroke Scale/Score [NIHSS] ≤5) with large vessel occlusion intended for intravenous thrombolysis alone, including those patients who eventually received thrombectomy because of END. END was defined as a ≥4-point NIHSS increase within 24 hours after admission. Mean age of participants was 70 years, median NIHSS was 3. Occlusion was located in the internal carotid artery (ICA)-T/L in 3%, in the tandem cervical ICA+middle cerebral artery in 10%, in the proximal M1 in 7%, in the distal M1 in 21%, in the M2 in 54%, and in the basilar artery in 4%. The thrombus was visible in 85% of patients.

END occurred in 12% and was associated with poor outcome after 3 months. In a multivariable analysis, a more proximal occlusion site (P<0.001) and a longer thrombus (P=0.002) were independently associated with END. Rates of END according to occlusion type were the following:

• ICA-T/L, 55%;
• Tandem occlusion, 23%;
• Proximal M1 occlusion, 19%;
• Distal M1 occlusion, 13%;
• Distal M2 occlusion, 5%;
• Basilar artery occlusion, 27%.

In patients with a thrombus length of <6, 6-9, 9-12, and ≥12 mm, respectively, END occurred in 5%, 7%, 15%, and 23%.

1. Seners P, et al. Abstract O2036, EAN 2020.

 



Posted on 9 September 202028 October 2020