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Research ArticleNeurointervention

Endovascular Thrombectomy of Calcified Emboli in Acute Ischemic Stroke: A Multicenter Study

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
American Journal of Neuroradiology March 2020, 41 (3) 464-468; DOI: https://doi.org/10.3174/ajnr.A6412
C.J. Maurer
aFrom the Departments of Diagnostic and Interventional Radiology and Neuroradiology (C.J.M., F.J., A.Berlis)
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T. Dobrocky
bUniversity Institute of Diagnostic and Interventional Neuroradiology (T.Dobrocky, J.G.), University of Bern, Inselspital, Bern, Switzerland
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F. Joachimski
aFrom the Departments of Diagnostic and Interventional Radiology and Neuroradiology (C.J.M., F.J., A.Berlis)
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U. Neuberger
cDepartment of Neuroradiology (U.N., M.A.M.), University of Heidelberg, Heidelberg, Germany
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T. Demerath
dDepartment of Neuroradiology (T.Demerath, A.Brehm, K.A.B., M.N.P.), Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
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A. Brehm
dDepartment of Neuroradiology (T.Demerath, A.Brehm, K.A.B., M.N.P.), Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
eDepartment of Neuroradiology (A.Brehm, M.N.P.), University Medical Center Göttingen, Göttingen, Germany
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A. Cianfoni
fDepartment of Neuroradiology (A.C.), Neurocenter of Southern Switzerland, Lugano, Switzerland
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B. Gory
gDepartment of Diagnostic and Therapeutic Neuroradiology (B.G.), University Hospital of Nancy, Institut National de la Santé et de la Recherche Médicale U1254, Nancy, France
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A. Berlis
aFrom the Departments of Diagnostic and Interventional Radiology and Neuroradiology (C.J.M., F.J., A.Berlis)
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J. Gralla
bUniversity Institute of Diagnostic and Interventional Neuroradiology (T.Dobrocky, J.G.), University of Bern, Inselspital, Bern, Switzerland
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M.A. Möhlenbruch
cDepartment of Neuroradiology (U.N., M.A.M.), University of Heidelberg, Heidelberg, Germany
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K.A. Blackham
dDepartment of Neuroradiology (T.Demerath, A.Brehm, K.A.B., M.N.P.), Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
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M.N. Psychogios
dDepartment of Neuroradiology (T.Demerath, A.Brehm, K.A.B., M.N.P.), Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
eDepartment of Neuroradiology (A.Brehm, M.N.P.), University Medical Center Göttingen, Göttingen, Germany
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P. Zickler
hNeurology and Neurophysiology (P.Z.), Universitätsklinikum Augsburg, Augsburg, Germany
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S. Fischer
iInstitut für Diagnostische und Interventionelle Radiologie, Neuroradiologie (S.F.), Nuklearmedizin, Knappschaftskrankenhaus Bochum-Langendreer, Universitätsklinik, Bochum, Germany.
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    Figure.

    Examples of calcified emboli (arrowheads) in the left M1 (A), right middle cerebral artery bifurcation (B), left M2 (C), and carotid T (D).

Tables

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    Table 1:

    Baseline patient characteristics (n = 40)

    Characteristics
    Demographic data and medical history
     Age (mean) (yr)78  ± 9.6
     Female sex68% (27/40)
     Current smoker8% (3/38)
     Hypertension74% (28/38)
     Diabetes mellitus39% (15/38)
     Hypercholesterolemia41% (15/37)
     Baseline NIHSS (mean)15.4 ± 7.2
    Pretreatment ASPECTS
     0–55.1% (2/39)
     6–1094.9% (37/39)
    IV thrombolysis47.5% (19/40)
    • View popup
    Table 2:

    Clot location and characteristics (n = 40)

    Characteristics
    Clot location (parent vessel)
     Right anterior circulation55% (22/40)
     Left anterior circulation37.5% (15/40)
     Posterior circulation7.5% (3/40)
    Clot location
     M165% (26/40)
     M212.5% (5/40)
     Carotid T15% (6/40)
     Basilar artery7.5% (3/40)
     Tandem pathology10% (4/40)
    Thrombus characteristics
     Maximal density (mean) (HU)327 ± 202
     Length (mean) (mm)9.2 ± 4.3
     Multiple emboli10% (4/40)
     CLASS score (mean)1.1 ± 0.7
     Range of CLASS score0–2.5
     Spontaneous embolization95% (38/40)
     Embolization during endovascular treatment5% (2/40)
    • View popup
    Table 3:

    Procedural characteristics

    Characteristics
    Unknown onset32.5% (13/40)
    Known onset to recanalization (n = 27/40) (mean) (min)316 ± 216
    Procedural time (mean) (min)93  ± 57
    No. of passes (mean)2.7 ± 1.7
    Range1–7
    Aspiration alone5% (2/40)
    Stent retrieval alone5% (2/40)
    Combination (stent retrieval and aspiration)90% (36/40)
    Additional intracranial stent placement5% (2/40)
    Angiographic results
     mTICI 025% (10/40)
     mTICI 17.5% (3/40)
     mTICI 2a10% (4/40)
     mTICI 2b32.5% (13/40)
     mTICI 325% (10/40)
    Successful recanalization after 1 pass30% (12/40)
    IV heparin35% (14/40)
    IV ASA10% (4/40)
    IA rtPA7.5% (3/40)
    • Note:—ASA indicates acetylsalicylic acid; IA, intra-arterial.

    • View popup
    Table 4:

    Clinical outcome

    Outcome
    Parenchymal hematoma type 1 and 27.5% (3/40)
    Symptomatic hemorrhage5.3% (2/38)
    90-Day mRS available85% (34/40)
     02.9% (1/34)
     117.1% (6/34)
     25.9% (2/34)
     35.9% (2/34)
     40% (0/34)
     511.8% (4/34)
     655.9% (19/34)
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American Journal of Neuroradiology: 41 (3)
American Journal of Neuroradiology
Vol. 41, Issue 3
1 Mar 2020
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Cite this article
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, S. Fischer
Endovascular Thrombectomy of Calcified Emboli in Acute Ischemic Stroke: A Multicenter Study
American Journal of Neuroradiology Mar 2020, 41 (3) 464-468; DOI: 10.3174/ajnr.A6412

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Endovascular Thrombectomy of Calcified Emboli in Acute Ischemic Stroke: A Multicenter Study
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, S. Fischer
American Journal of Neuroradiology Mar 2020, 41 (3) 464-468; DOI: 10.3174/ajnr.A6412
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