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

Maurer, C J; Dobrocky, Tomas; Joachimski, F; Neuberger, U; Demerath, T; Brehm, A; Cianfoni, A; Gory, B; Berlis, A; Gralla, Jan; Möhlenbruch, M A; Blackham, K A; Psychogios, M N; Zickler, P; Fischer, S (2020). Endovascular Thrombectomy of Calcified Emboli in Acute Ischemic Stroke: A Multicenter Study. AJNR. American journal of neuroradiology, 41(3), pp. 464-468. American Society of Neuroradiology 10.3174/ajnr.A6412

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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.

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