Clinical Research Of Thrombus Migration In Patients With Acute Middle Cerebral Artery Occlusion After Mechanical Thrombectomy

Objective: Stroke has become the second leading cause of deadly disease and most frequent cause of disabling disease in the world,of which about 85% are ischemic strokes.Thrombus migration can occur in approximately 30% of patients with acute ischemic stroke.This study was designed to investigate the imaging and clinical prognosis of thrombus migration after thrombectomy.Methods : Retrospective analysis was done of 48 patients with isolated middle cerebral artery occlusions treated with endovascular thrombectomy.TM was observed(1)by analyzing discrepancies between computed tomographic angiography and digital subtraction angiography and(2)by comparing infarct pattern in the striatocapsular region with exact,angiographically assessed thrombus location within the M1-segment and the involvement of the middle cerebral artery perforators.Patients were divided into two groups according to the sign of TM: positive group and negative group.Baseline characteristics,,m TICI scale,7-day NIHSS score,and 90-day m RS score were compared between the two groups.Results: Thirteen patients patients showed signs of TM.The two group had no difference in gender(53.8% vs 54.3%,P=0.978),age(69.7±14.1 vs 67.5±14.2,P=0.223),smoking history(15.4% vs 31.4%,P=0.456),stroke history(30.8% vs 22.9%,P=0.851),atrial fibrillation(53.8% vs 40%,P=0.390),hypertension(61.5% vs 71.4%,P=0.759),diabetes(15.4% vs 25.7%,P=0.711),baseline systolic blood pressure(135(129-145)vs 136(125-146),P=0.726),baseline blood glucose(6.5(5.8-7.75)vs 6.4(5.9)-8.1),P=0.917),baseline NIHSS score(16(12-20)vs 13(10-15),P=0.057),rates of bridging approach(30.8% vs 40%,P=0.801),onset to recanalization time(377.7±121.2 vs 343.7±139.1,P=0.737),successful reperfusion(84.6% vs 94.3%,P=0.624)and first-pass recanalization(38.5% vs 51.7%,P=0.250).There was a statistically significant difference in complete recanalization(46.2% vs 85.7%,P=0.015),symptomatic intracranial haemorrhage(61.5% vs 25.7%,P=0.049),7-days NIHSS score(P=0.031),functional indipendence(m RS ? 2)(30.8% vs 65.7%,P=0.03),between the two groups.Conclusions: Thrombus migration is associated with lower rates of complete recanalization,higher rate of s ICH and poor functional outcome in patients with acute ischemic stroke after mechanical thrombectomy.