{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T02:43:09Z","timestamp":1789699389492,"version":"4.0.1"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Distal embolization (DE) is a common complication of endovascular treatment (EVT). We investigated the association of radiological thrombus characteristics and treatment details with DE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Patients with thin-slice (\u22642.5 mm) baseline noncontrast computed tomography and computed tomography angiography from the ESCAPE-NA1 trial (Efficacy and Safety of Nerinetide for the Treatment of Acute Ischemic Stroke) were included. Thrombus annotation was performed manually on coregistered scans by experienced readers. We assessed thrombus location, distance from internal carotid artery terminus, length, perviousness, absolute attenuation, and hyperdense artery sign. In addition, we evaluated balloon guide catheter use during EVT, first-line EVT approach, the number of thrombectomy passes, and prior intravenous thrombolysis administration. DE was defined as the occurrence of emboli distal to the target artery or in new territories during EVT. The association between thrombus characteristics, treatment details, and DE was evaluated using descriptive statistics and multivariable mixed-effects logistic regression, resulting in adjusted odds ratios (aOR) with 95% CI. Interaction between IVT and radiological thrombus characteristics was assessed by adding interaction terms in separate models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      In total, 496 out of 1105 (44.9%) ESCAPE-NA1 patients were included. DE was detected in 251 out of 496 patients (50.6%). Patients with DE had longer thrombi (median, 28.5 [interquartile range, 20.8\u201342.3] mm versus 24.4 [interquartile range, 17.1\u201332.4] mm;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.01). There were no statistically significant differences in the other thrombus characteristics. Factors associated with DE were thrombus length (aOR, 1.02 [95% CI, 1.01\u20131.04]), balloon guide catheter use (aOR, 0.49 [95% CI, 0.29\u20130.85]), and number of passes (aOR, 1.24 [95% CI, 1.04\u20131.47]). In patients with hyperdense artery sign, IVT was associated with reduced odds of DE (aOR, 0.55 [95% CI, 0.31\u20130.97]),\n                      <jats:italic>P<\/jats:italic>\n                      for interaction=0.04.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>DE was associated with longer thrombi, no balloon guide catheter use, and more EVT passes. IVT was associated with a reduced risk of DE in patients with hyperdense artery sign. These findings may support treatment decisions on IVT and EVT approaches.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.122.040542","type":"journal-article","created":{"date-parts":[[2023,1,23]],"date-time":"2023-01-23T14:00:59Z","timestamp":1674482459000},"page":"448-456","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":38,"title":["Distal Embolization in Relation to Radiological Thrombus Characteristics, Treatment Details, and Functional Outcome"],"prefix":"10.1161","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6748-2081","authenticated-orcid":true,"given":"Fouzi","family":"Bala","sequence":"first","affiliation":[{"name":"Department of Clinical Neurosciences and Diagnostic Imaging (F.B., J.M.O., P.C., W.Q., N.S., K.Z., A.W., M.A.A., B.K.M., M.D.H., M.G.), University of Calgary, Canada."},{"name":"Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, France (F.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5250-8955","authenticated-orcid":true,"given":"Manon","family":"Kappelhof","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine (M.K., N.A.T., H.M., C.M.), Amsterdam UMC location University of Amsterdam, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0029-6764","authenticated-orcid":true,"given":"Johanna M.","family":"Ospel","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences and Diagnostic Imaging (F.B., J.M.O., P.C., W.Q., N.S., K.Z., A.W., M.A.A., B.K.M., M.D.H., M.G.), University of Calgary, Canada."},{"name":"Department of Radiology, University Hospital of Basel, Switzerland (J.M.O.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8058-383X","authenticated-orcid":true,"given":"Petra","family":"Cimflova","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences and Diagnostic Imaging (F.B., J.M.O., P.C., W.Q., N.S., K.Z., A.W., M.A.A., B.K.M., M.D.H., M.G.), University of Calgary, Canada."},{"name":"Department of Radiology (P.C., M.A.A., B.K.M., M.D.H.), University of Calgary, Canada."},{"name":"Department of Medical Imaging, St Anne\u2019s University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic (P.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7827-8270","authenticated-orcid":true,"given":"Wu","family":"Qiu","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences and Diagnostic Imaging (F.B., J.M.O., P.C., W.Q., N.S., K.Z., A.W., M.A.A., B.K.M., M.D.H., M.G.), University of Calgary, Canada."},{"name":"School of Life Science and Technology, Huazhong University of Science and Technology (W.Q.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3647-0904","authenticated-orcid":true,"given":"Nishita","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences and Diagnostic Imaging (F.B., J.M.O., P.C., W.Q., N.S., K.Z., A.W., M.A.A., B.K.M., M.D.H., M.G.), University of Calgary, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9363-7304","authenticated-orcid":true,"given":"Kairan","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences and Diagnostic Imaging (F.B., J.M.O., P.C., W.Q., N.S., K.Z., A.W., M.A.A., B.K.M., M.D.H., M.G.), University of Calgary, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2719-3012","authenticated-orcid":true,"given":"Beom Joon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea (B.J.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4898-8495","authenticated-orcid":true,"given":"Ankur","family":"Wadhwa","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences and Diagnostic Imaging (F.B., J.M.O., P.C., W.Q., N.S., K.Z., A.W., M.A.A., B.K.M., M.D.H., M.G.), University of Calgary, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9550-8197","authenticated-orcid":true,"given":"Mohammed A.","family":"Almekhlafi","sequence":"additional","affiliation":[{"name":"Department of 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Medicine (M.K., N.A.T., H.M., C.M.), Amsterdam UMC location University of Amsterdam, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6269-1543","authenticated-orcid":true,"given":"Michael D.","family":"Hill","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences and Diagnostic Imaging (F.B., J.M.O., P.C., W.Q., N.S., K.Z., A.W., M.A.A., B.K.M., M.D.H., M.G.), University of Calgary, Canada."},{"name":"Department of Radiology (P.C., M.A.A., B.K.M., M.D.H.), University of Calgary, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9060-2109","authenticated-orcid":true,"given":"Mayank","family":"Goyal","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences and Diagnostic Imaging (F.B., J.M.O., P.C., W.Q., N.S., K.Z., A.W., M.A.A., B.K.M., M.D.H., M.G.), University of Calgary, 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