TY - JOUR
T1 - Association of clot burden score with radiographic and clinical outcomes following Solitaire stent retriever thrombectomy
T2 - Analysis of the SWIFT PRIME trial
AU - Mokin, Maxim
AU - Levy, Elad I.
AU - Siddiqui, Adnan H.
AU - Goyal, Mayank
AU - Nogueira, Raul G.
AU - Yavagal, DIleep R.
AU - Pereira, Vitor M.
AU - Saver, Jeffrey L.
N1 - Funding Information:
Competing interests EIL is a scientific consultant to Medtronic; has shareholder/ ownership interest with Intratech Medical Ltd, Blockade Medical LLC; has received fees from Abbott for carotid training; and has served as an expert witness for Renders medical/legal opinion. AHS has financial interests in Hotspur, Intratech Medical, StimSox, Valor Medical Blockage Medical, Lazarus Effect, Pulsar Vascular, and Medina Medical, Inc; has served as a scientific consultant to Medtronic, Codman & Shurtleff, Inc, GuidePoint Global Consulting, Penumbra, Stryker, Pulsar Vascular, Microvention, Lazarus Effect, Blockade Medical, and Reverse Medical; is part of the speakers’ bureaus at Codman & Shurtleff, Inc; is on the advisory board for Medtronic Neurovascular, Codman & Shurtleff, Inc, ICAVL, and Medina Medical, Inc; and has received an honoraria from Abbott Vascular, Abbott Vascular, and Codman & Shurtleff, Inc, for physician training, Penumbra, Inc. MG served as a consultant to Medtronic for design and conduct of the SWIFT PRIME trial; received honoraria from Medtronic/Covidien for speaking and teaching engagements; and was one of the principal investigators for the ESCAPE trial. The ESCAPE trial was partially funded by Covidien through an unrestricted research grant to the University of Calgary. RGN is a scientific consultant for trial design and conduct to Medtronic; has served as the principal investigator for the TREVO-2 and DAWN trials; is part of the Penumbra 3D Separator trial executive committee; has served as a Data and Safety Monitoring Board member for Stroke Trial with Rapid Medical; and is the editor-in-chief of the Interventional Neurology journal. DRY is a scientific consultant for trial design and conduct to Medtronic and was an ESCAPE trial DSCMB member. VMP is a scientific consultant for trial design and conduct to Medtronic. The University of California, Regents receives funding for the services of JLS as a scientific consultant for trial design and conduct to Covidien and Stryker, and is an employee of the University of California, which holds a patent on retriever devices for stroke. Ethics approval Local institutional review board or ethics committee with concomitant registration of the clinical trial. Provenance and peer review Not commissioned; externally peer reviewed. Data sharing statement All data were presented in the paper.
PY - 2017/10
Y1 - 2017/10
N2 - Background The clot burden score (CBS) was developed as a tool to evaluate the extent of intracranial thrombus burden in patients with anterior circulation acute ischemic stroke. CBS is based on the presence or absence of contrast opacification on CT angiography (CTA). Its value in predicting radiographic and clinical outcomes in patients given endovascular stroke therapy remains unknown. Objective To evaluate the relationship between CBS and outcomes after stent retriever thrombectomy in the interventional arm of the SWIFT PRIME trial. Methods CBS was calculated for the endovascular arm (IV tissue plasminogen activator plus Solitaire stent retriever) of SWIFT PRIME using baseline CTA. The cohort of 69 patients was divided into three groups according to their CBS values: CBS 0-5 (n=14), CBS 6-7 (n=23), and CBS 8-9 (n=32). Results The mean age of the 69 patients who formed the study cohort was 63.2-13.1 years, mean National Institutes of Health Stroke Scale score was 16.8-4.5, and 55% of the patients were male. There was no difference in clinical characteristics among the three groups, except for the baseline Alberta Stroke Program Early CT Score (p=0.049). The site of proximal occlusion varied significantly among the three groups ( p0.001). Rates of successful recanalization (TICI 2b/3), complete recanalization (TICI 3 only) and of good clinical outcome at 3 months were similar among the three groups (p=0.24, p=0.35, and p=0.52, respectively). Conclusions The combination of IV thrombolysis and stent retriever thrombectomy with the Solitaire device is highly effective in achieving successful recanalization and a good clinical outcome throughout the entire range of CBS values.
AB - Background The clot burden score (CBS) was developed as a tool to evaluate the extent of intracranial thrombus burden in patients with anterior circulation acute ischemic stroke. CBS is based on the presence or absence of contrast opacification on CT angiography (CTA). Its value in predicting radiographic and clinical outcomes in patients given endovascular stroke therapy remains unknown. Objective To evaluate the relationship between CBS and outcomes after stent retriever thrombectomy in the interventional arm of the SWIFT PRIME trial. Methods CBS was calculated for the endovascular arm (IV tissue plasminogen activator plus Solitaire stent retriever) of SWIFT PRIME using baseline CTA. The cohort of 69 patients was divided into three groups according to their CBS values: CBS 0-5 (n=14), CBS 6-7 (n=23), and CBS 8-9 (n=32). Results The mean age of the 69 patients who formed the study cohort was 63.2-13.1 years, mean National Institutes of Health Stroke Scale score was 16.8-4.5, and 55% of the patients were male. There was no difference in clinical characteristics among the three groups, except for the baseline Alberta Stroke Program Early CT Score (p=0.049). The site of proximal occlusion varied significantly among the three groups ( p0.001). Rates of successful recanalization (TICI 2b/3), complete recanalization (TICI 3 only) and of good clinical outcome at 3 months were similar among the three groups (p=0.24, p=0.35, and p=0.52, respectively). Conclusions The combination of IV thrombolysis and stent retriever thrombectomy with the Solitaire device is highly effective in achieving successful recanalization and a good clinical outcome throughout the entire range of CBS values.
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U2 - 10.1136/neurintsurg-2016-012631
DO - 10.1136/neurintsurg-2016-012631
M3 - Article
C2 - 27634952
AN - SCOPUS:85032456047
VL - 9
SP - 929
EP - 932
JO - Journal of NeuroInterventional Surgery
JF - Journal of NeuroInterventional Surgery
SN - 1759-8478
IS - 10
ER -