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May 16, 2019

ESOC-2019

THROMBUS PERVIOUSNESS IN ACUTE ISCHEMIC STROKE: A SYSTEMATIC REVIEW.

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acute ischemic stroke

perviousness

imaging

endovascular treatment

intravenous thrombolysis

Abstract

Abstract

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Keywords

acute ischemic stroke

perviousness

imaging

endovascular treatment

intravenous thrombolysis

Abstract

Background: Thrombus perviousness estimates residual flow through a clot combining non-contrast CT and CTA images. Perviousness was reported to reflect thrombus histopathology, and may be associated with response to stroke treatment. We aimed to summarize the available evidence on thrombus perviousness in relation to functional outcome after intravenous thrombolysis (IVT) and/or endovascular treatment (EVT), in addition to its relation with other radiological thrombus characteristics. Methods: Two authors systematically searched PubMed and conference abstracts, using the search terms ‘thrombus’, ‘perviousness’, ‘stroke’, and synonyms. We included studies on thrombus perviousness in acute ischemic stroke in humans describing 1 of our outcome measures of interest. Our outcomes of interest were 90-day functional independence (mRS 0-2), successful recanalization, angiographic reperfusion, and association of perviousness with thrombus length and occlusion location. Results: Of 252 search results, 12 studies and 2 additional conference abstracts were included, describing 2.815 patients in total. All studies describing functional outcome after IVT (n=5) found a significantly positive relationship between perviousness and functional independence. Three studies reporting on functional independence after EVT showed positive yet non-significant associations. Patients with pervious thrombi more often showed recanalization on first angiography run or follow-up CTA in seven studies (predominantly after IVT; significant in n=5). Studies reporting angiographic reperfusion after EVT showed non-significant (n=2, thrombectomy) or significantly positively effects (n=1, intra-arterial thrombolysis). Increased perviousness corresponded to decreased clot length (n=3) and more distal occlusion location (n=3). Conclusions: Patients with pervious thrombi respond better to IVT. Effect of thrombus perviousness on outcome of EVT is inconclusive.

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© Copyright 2019 Morressier GmbH.
All rights reserved.