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Master Thesis

Valeurs étiologique et pronostique de la détection de thrombus dans le territoire carotidien externe lors du traitement endovasculaire des occlusions aiguës de la circulation antérieure

Abstract : Background and Purpose: an early understanding of stroke mechanism may improve treatment and outcome in patients presenting with large vessel occlusion stroke (LVOS) treated with mechanical thrombectomy (MT). We aimed to investigate whether spontaneous external carotid artery (ECA) embolism detection during MT was associated with stroke etiology and clinical outcome. Methods: we retrospectively reviewed our prospectively maintained institutional database including consecutive patients with anterior circulation LVOS treated with MT between January 2015 and August 2020. MT digitally subtracted angiographies were reviewed by two neuroradiologists. Results: among 1298 patients, an ECA embolus was detected in 68 (5.2%). The Kappa coefficient for interobserver agreement was 0.89 (95% IC 0.82 to 0.95). ECA embolism was significantly associated with intracranial internal carotid artery occlusion (p<0.001), cardioembolic etiology (p<0.001) and lower clot burden score (p<0.001). Day-1 delta NIHSS (aOR=-2.7; 95% CI -4.9 to 0.3; p=0,021) and delta ASPECTS (aOR=0.9; 95% CI, 0.2 to 1.5; p=0.004) were poorer among ECA embolism patients. There was no significant difference in 3-months functional outcome between groups (aOR=0.8; 95% CI, 0.42 to 1.52; p=0.50). In the secondary analysis excluding patients with early recanalization before any intracranial MT maneuver, we also found a significantly lower successful reperfusion rate (aOR=0.45; 95% CI, 0.24 to 0.84; p=0.011), a lower rate of first pass effect (aOR= 0.46; 95% CI, 0.25 to 0.85; p=0.011) and a higher number of MT passes (aOR=1.37; 95% CI, 1.15 to 1.62; p<0.001) in the ECA emboli group. Conclusion: in patients with anterior circulation LVOS treated with MT, ECA embolism was significantly associated with cardioembolic etiology and high thrombus burden. Regarding secondary clinical endpoints, ECA emboli were also associated with poorer early outcome. This underexplored angiographic pattern might be a valuable etiologic clue for anterior circulation LVOS and may also help adapting revascularization strategy to high clot burden ruling out underlying arterial wall disease such as atherosclerosis or dissection.
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https://dumas.ccsd.cnrs.fr/dumas-03389043
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Submitted on : Wednesday, October 20, 2021 - 6:32:18 PM
Last modification on : Wednesday, December 8, 2021 - 3:55:31 AM

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  • HAL Id : dumas-03389043, version 1

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Thomas Courret. Valeurs étiologique et pronostique de la détection de thrombus dans le territoire carotidien externe lors du traitement endovasculaire des occlusions aiguës de la circulation antérieure. Sciences du Vivant [q-bio]. 2021. ⟨dumas-03389043⟩

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