Abstract
Purpose: The angiographic visualization of the stent during mechanical thrombectomy (MT) may
provide information regarding the characteristics of the underlying occluding clot,
device-clot interaction, and recanalization. The purpose of this study was to evaluate
the open stent sign in relation to the retrieved clot and recanalization.
Methodology
78 patients treated with the stent retriever for acute stroke were retrospectively
reviewed. The open stent sign was defined as full opening (>80% of normal vessel diameter)
of the stent on DSA after deployment across the occlusion. The retrieved clot was
visually classified as red or non-red clots. The relationship between the open stent
sign and the patient characteristics, recanalization, retrieved clot, and clinical
outcome were analyzed.
Results
Overall successful recanalization and good outcome was achieved in 68 (87.2%) and
35 (44.9%) patients, respectively. Open stent sign was seen in 52 patients (66.7%).
Occlusions showing positive open stent sign was associated with significantly higher
first pass effect (44.2% vs 19.2%, p=0.044) and successful recanalization rate (94.2%
vs 73.1%, p=0.013) compared to negative open stent sign. The open stent sign was associated
with higher incidence of red clot (75.0% vs 38.9%, p=0.008). On multivariate analysis,
the open stent sign (OR 22.721, 95% CI 1.953-264.372, p=0.013) was a predictor of
successful recanalization.
Conclusions
The visualization of the open stent during MT of acute ischemic stroke may provide
added information in terms of clot characteristics and procedural success. The open
stent sign is associated with red clots, higher first pass effect and successful recanalization.
Key Words
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Article info
Publication history
Published online: October 21, 2021
Accepted:
October 6,
2021
Received in revised form:
September 28,
2021
Received:
June 30,
2021
Footnotes
No funding was received to assist with the preparation of this manuscript
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106168
Copyright
© 2021 Elsevier Inc. All rights reserved.
