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Endovascular thrombectomy of calcified emboli in acute ischemic stroke: a multicenter study

Background and purpose: Large intracranial vessel occlusion due to calcified emboli is a rare cause of major stroke. We assessed the prevalence, imaging appearance, the effectiveness of mechanical thrombectomy, and clinical outcome of patients with large-vessel occlusion due to calcified emboli. - M...

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Main Authors: Maurer, Christoph J. (Author) , Dobrocky, T. (Author) , Joachimski, F. (Author) , Neuberger, Ulf (Author) , Demerath, T. (Author) , Brehm, A. (Author) , Cianfoni, A. (Author) , Gory, B. (Author) , Berlis, A. (Author) , Gralla, J. (Author) , Möhlenbruch, Markus Alfred (Author) , Blackham, K. A. (Author) , Psychogios, M. N. (Author) , Zickler, P. (Author) , Fischer, S. (Author)
Format: Article (Journal)
Language:English
Published: March 17, 2020
In: American journal of neuroradiology
Year: 2020, Volume: 41, Issue: 3, Pages: 464-468
ISSN:1936-959X
DOI:10.3174/ajnr.A6412
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.3174/ajnr.A6412
Verlag, lizenzpflichtig, Volltext: http://www.ajnr.org/content/41/3/464
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Author Notes:C.J. Maurer, T. Dobrocky, F. Joachimski, U. Neuberger, T. Demerath, A. Brehm, A. Cianfoni, B. Gory, A. Berlis, J. Gralla, M.A. Möhlenbruch, K.A. Blackham, M.N. Psychogios, P. Zickler, and S. Fischer
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Summary:Background and purpose: Large intracranial vessel occlusion due to calcified emboli is a rare cause of major stroke. We assessed the prevalence, imaging appearance, the effectiveness of mechanical thrombectomy, and clinical outcome of patients with large-vessel occlusion due to calcified emboli. - Materials and methods: We performed a retrospective analysis of clinical and procedural data of consecutive patients who underwent mechanical thrombectomy due to calcified emboli in 7 European stroke centers. - Results: We screened 2969 patients, and 40 patients matched the inclusion criteria, accounting for a prevalence of 1.3%. The mean maximal density of the thrombus was 327 HU (range, 150-1200 HU), and the mean thrombus length was 9.2 mm (range, 4-20 mm). Four patients had multiple calcified emboli, and 2 patients had an embolic event during an endovascular intervention. A modified TICI score of ≥2b was achieved in 57.5% (23/40), with minimal-to-no reperfusion (modified TICI 0-1) in 32.5% (13/40) and incomplete reperfusion (modified TICI 2a) in 10% (4/40). Excellent outcome (mRS 0-1) was achieved in only 20.6%, functional independence (mRS 0-2) in 26.5% and 90-day mortality was 55.9%. - Conclusions: Acute ischemic stroke with large-vessel occlusion due to calcified emboli is a rare entity in patients undergoing thrombectomy, with considerably worse angiographic outcome and a higher mortality compared with patients with noncalcified thrombi. Good functional recovery at 3 months can still be achieved in about a quarter of patients.
Item Description:Gesehen am 30.04.2020
Physical Description:Online Resource
ISSN:1936-959X
DOI:10.3174/ajnr.A6412

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