Clot permeability linked to first-attempt success of aspiration
thrombectomy

Date:
August 11, 2020
Source:
University of South Florida (USF Health)
Summary:
A multicenter study reports that clot perviousness, or permeability
- the ability for contrast used during the initial imaging workup to
seep through a clot, as estimated by CT imaging - is associated with
''first- pass success'' in large vessel occlusion (LVO) strokes
initially treated with an aspiration thrombectomy approach. LVO
stroke treatment success using a stent retriever-first approach
to remove the brain vessel blockage was less dependent on clot
perviousness.



FULL STORY ==========================================================================
In certain patients suffering a severe ischemic stroke, a mechanical
device can be used to remove a clot blocking blood flow to the brain. The minimally invasive procedure either suctions the clot directly out of
a large artery to the brain (known as aspiration thrombectomy), or by
grabbing and extracting the blockage with a stent (stent-retrieval thrombectomy). Last year, a major trial known as COMPASS found both catheter-guided techniques to be equally safe and effective as first-line approaches for treating emergent large vessel occlusions (ELVO), the
most destructive type of ischemic stroke.


==========================================================================
Now, a multicenter study led by the University of South Florida Health
(USF Health) Department of Neurosurgery and Tampa General Hospital,
reports that clot perviousness, or permeability -- the ability for
contrast used during the initial imaging workup to seep through a clot,
as estimated by CT imaging -- is associated with "first-pass success" in
ELVO patients initially treated with the aspiration thrombectomy approach.

Findings from this posthoc analysis of 165 eligible patients enrolled
in the COMPASS trial were published July 17 in the Journal of Neurointerventional Surgery.

First-pass success means achieving complete reopening of a blocked artery
in the first attempt with a thrombectomy device. The treatment success
of the stent retriever-first approach for a large vessel occlusion stroke
was less dependent on clot perviousness, the study found. Time-sensitive, successful removal of the clot restores blood flow (and therefore oxygen)
to the brain, improving the likelihood of faster stroke recovery and
reduced complications and disability.

The data is the first to indicate that highly pervious clots may result
in better treatment success after first attempt clot removal using the aspiration thrombectomy technique. However, clots with low perviousness
are more resistant to either thrombectomy approach, the researchers
report, and more research is needed to determine the most effective way
to treat ELVO in this population of patients.

"Currently, physicians who treat strokes with thrombectomy are 'in
the dark.' We have a variety of tools available but, frankly, we often
don't know which particular device will be most effective in a particular patient," said the paper's lead author Max Mokin, MD, PhD, associate
professor of neurosurgery and neurology at the USF Health Morsani
College of Medicine and Tampa General Hospital. "This study provides
the first set of clues to guide us in selecting the devices (aspiration
and/or stent retrievers) that may provide the most advantage, making
the thrombectomy procedure safer, faster and ultimately more effective."
Dr. Mokin specializes in neurointerventional surgery for the USF Health
and Tampa General Hospital, one of the largest academic medical centers
in Florida.

He leads a three-year National Institutes of Health grant investigating
how patient brain vessel anatomy interacts with clot removal devices. The
goal is to optimize endovascular approaches for treating acute ischemic
stroke, a leading cause of death and long-term disability worldwide.


========================================================================== Story Source: Materials provided by
University_of_South_Florida_(USF_Health). Original written by Anne
DeLotto Baier. Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Maxim Mokin, Muhammad Waqas, Johanna Fifi, Reade De Leacy, David
Fiorella, Elad I Levy, Kenneth Snyder, Ricardo Hanel, Keith
Woodward, Imran Chaudry, Ansaar T Rai, Donald Frei, Josser E
Delgado Almandoz, Michael Kelly, Adam S Arthur, Blaise W Baxter,
Joey English, Italo Linfante, Kyle M Fargen, Aquilla Turk, Adnan H
Siddiqui, J Mocco. Clot perviousness is associated with first pass
success of aspiration thrombectomy in the COMPASS trial. Journal
of NeuroInterventional Surgery, 2020; neurintsurg-2020-016434 DOI:
10.1136/neurintsurg-2020- 016434 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/08/200811120124.htm

--- up 3 weeks, 6 days, 1 hour, 55 minutes
* Origin: -=> Castle Rock BBS <=- Now Husky HPT Powered! (1337:3/111)