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Thrombus Migration and Fragmentation After Intravenous Alteplase Treatment: The INTERRSeCT Study

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Author(s)
Tomoyuki OharaBijoy K. MenonFahad S. Al-AjlanMacKenzie HornMohamed NajmAbdulaziz Al-SultanJosep PuigDar DowlatshahiAna I. Calleja SanzSung-Il SohnSeong H. AhnAlexandre Y. PoppeRobert MikulikNegar AsdaghiThalia S. FieldAlbert JinTalip AsilJean-Martin BoulangerFederica LetteriSadanand DeyJames W. EvansMayank GoyalMichael D. HillMohammed AlmekhlafiAndrew M. Demchuk
Keimyung Author(s)
Sohn, Sung Il
Department
Dept. of Neurology (신경과학)
Journal Title
Stroke
Issued Date
2021
Volume
52
Abstract
Background and Purpose:
There is interest in what happens over time to the thrombus after intravenous alteplase. We study the effect of alteplase on thrombus structure and its impact on clinical outcome in patients with acute stroke.

Methods:
Intravenous alteplase treated stroke patients with intracranial internal carotid artery or middle cerebral artery occlusion identified on baseline computed tomography angiography and with follow-up vascular imaging (computed tomography angiography or first run of angiography before endovascular therapy) were enrolled from INTERRSeCT study (Identifying New Approaches to Optimize Thrombus Characterization for Predicting Early Recanalization and Reperfusion With IV Alteplase and Other Treatments Using Serial CT Angiography). Thrombus movement after intravenous alteplase was classified into complete recanalization, thrombus migration, thrombus fragmentation, and no change. Thrombus migration was diagnosed when occlusion site moved distally and graded according to degrees of thrombus movement (grade 0–3). Thrombus fragmentation was diagnosed when a new distal occlusion in addition to the primary occlusion was identified on follow-up imaging. The association between thrombus movement and clinical outcome was also evaluated.

Results:
Among 427 patients in this study, thrombus movement was seen in 54% with a median time of 123 minutes from alteplase administration to follow-up imaging, and sub-classified as marked (thrombus migration grade 2–3 + complete recanalization; 27%) and mild to moderate thrombus movement (thrombus fragmentation + thrombus migration grade 0–1; 27%). In patients with proximal M1/internal carotid artery occlusion, marked thrombus movement was associated with a higher rate of good outcome (90-day modified Rankin Scale, 0–2) compared with mild to moderate movement (52% versus 27%; adjusted odds ratio, 5.64 [95% CI, 1.72–20.10]). No difference was seen in outcomes between mild to moderate thrombus movement and no change. In M1 distal/M2 occlusion, marked thrombus movement was associated with improved 90-day good outcome compared with no change (70% versus 56%; adjusted odds ratio, 2.54 [95% CI, 1.21–5.51]).

Conclusions:
Early thrombus movement is common after intravenous alteplase. Marked thrombus migration leads to good clinical outcomes. Thrombus dynamics over time should be further evaluated in clinical trials of acute reperfusion therapy.
Keimyung Author(s)(Kor)
손성일
Publisher
School of Medicine (의과대학)
Citation
Tomoyuki Ohara et al. (2021). Thrombus Migration and Fragmentation After Intravenous Alteplase Treatment: The INTERRSeCT Study. Stroke, 52, 203–212. doi: 10.1161/STROKEAHA.120.029292
Type
Article
ISSN
1524-4628
Source
https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.029292
DOI
10.1161/STROKEAHA.120.029292
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/43494
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Neurology (신경과학)
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