Correlation between thrombus migration before mechanical thrombectomy and clinical data in patients with acute ischemic stroke

doi:10.3877/cma.j.issn.1673-9248.2026.03.008

Abstract

Abstract:

Objective

To explore the relationship between thrombus migration before mechanical thrombectomy and intravenous thrombolysis in patients with acute ischemic stroke (AIS), as well as its impact on the surgical process and clinical prognosis.

Methods

A total of 378 patients with anterior circulation AIS who underwent mechanical thrombectomy in the Department of Neurology, Huaian First Hospital Affiliated to Nanjing Medical University from January 2020 to December 2024 were enrolled in the study. According to the status of thrombus migration [changes in thrombus location between admission cranial CT angiography (CTA) and pre-thrombectomy digital subtraction angiography (DSA)], the patients were divided into the thrombus migration group (n=63) and the thrombus stability group (n=315). T-test, Mann-Whitney U test, and Chi-square test were used to compare the differences in baseline clinical characteristics, surgical process, and 90-day prognosis between the two groups. Multivariate Logistic regression analysis was performed to identify the independent influencing factors of thrombus migration.

Results

There were no statistically significant differences between the two groups in age, gender, past medical history, baseline National Institutes of Health stroke scale (NIHSS) score, baseline Alberta stroke program early CT score (ASPECTS), CTA thrombus location, time intervals, number of thrombectomy attempts, vascular recanalization status, symptomatic intracerebral hemorrhage, and other aspects (all P＞0.05). Compared with the thrombus stability group, the thrombus migration group had a lower proportion of cardioembolic etiology (31.75% vs 46.67%), while a higher proportion of patients received recombinant tissue plasminogen activator (rt-PA) intravenous thrombolysis (49.21% vs 28.57%), underwent stent thrombectomy (88.89% vs 75.24%), and achieved good 90-day prognosis (68.25% vs 52.70%), with statistically significant differences (χ²=4.739, 10.271, 5.613, 5.139; P=0.030, 0.001, 0.018, 0.023). Multivariate Logistic regression analysis showed that cardioembolic etiology was an independent protective factor for thrombus migration (OR=0.543, 95%CI: 0.302 – 0.974, P=0.041), and rt-PA intravenous thrombolysis was an independent risk factor for thrombus migration (OR=2.424, 95%CI: 1.382 – 4.252, P=0.002).

Conclusion

Thrombus migration before mechanical thrombectomy in patients with acute ischemic stroke does not affect vascular recanalization outcomes, but is associated with good 90-day prognosis. Cardioembolic etiology can reduce the risk of thrombus migration, while rt-PA intravenous thrombolysis can increase this risk.

Key words: Acute ischemic stroke, Thrombus migration, Intravenous thrombolysis, Mechanical thrombectomy, Clinical prognosis

Liao Wu, Shikun Cai, Peng Zuo, Guihua Ni, Xiaoyu Ni. Correlation between thrombus migration before mechanical thrombectomy and clinical data in patients with acute ischemic stroke[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2026, 20(03): 287-293.

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URL: https://zhnxgbzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1673-9248.2026.03.008

https://zhnxgbzz.cma-cmc.com.cn/EN/Y2026/V20/I03/287

Figures/Tables 3

CTA血栓位置	DSA血栓位置						合计
CTA血栓位置	ICA末端	M1近端	M1远端	M2	A1	A2	合计
ICA末端	-	9	5	1	-	1	16
M1近端	-	-	26	10	-	-	36
M1远端	-	-	-	9	-	-	9
M2	-	-	-	-	-	-	0
A1	-	-	-	-	-	2	2
A2	-	-	-	-	-	-	0

项目	血栓迁移组（n=63）	血栓稳定组（n=315）	统计值	P值
年龄（岁， $x ¯$ ±s）	66.52±12.49	65.32±13.68	t=0.645	0.520
男性[例（%）]	36（57.14）	191（60.63）	χ²=0.267	0.605
既往史[例（%）]
脑卒中或TIA	4（6.35）	24（7.62）	χ²=0.008	0.930
高血压	41（65.08）	183（58.10）	χ²=1.061	0.303
糖尿病	18（28.57）	96（30.48）	χ²=0.090	0.764
高脂血症	9（14.29）	50（15.87）	χ²=0.100	0.751
心房颤动	24（38.10）	156（49.52）	χ²=2.749	0.097
基线NIHSS评分（分， $x ¯$ ±s）	16.73±7.25	17.63±6.38	t=0.998	0.319
基线ASPECTS（分， $x ¯$ ±s）	7.76±1.04	7.68±1.11	t=0.528	0.598
TOAST病因分型[例（%）]			χ²=4.739	0.030
非心源性栓塞型	43（68.25）	168（53.33）
心源性栓塞型	20（31.75）	147（46.67）
CTA血栓位置[例（%）]			χ²=1.193	0.551
颈内动脉	16（25.40）	102（32.38）
大脑中动脉	45（71.43）	204（64.76）
大脑前动脉	2（3.17）	9（2.86）
rt-PA静脉溶栓[例（%）]	31（49.21）	90（28.57）	χ²=10.271	0.001
时间节段[min，M（Q₁，Q₃）]
CTA至首次DSA时间	58（48，69）	61（50，72）	Z=-1.369	0.135
发病至股动脉穿刺时间	211（153，333）	223（156，328）	Z=-0.195	0.842
穿刺至血管再通时间	60（50，65）	50（35，85）	Z=-0.354	0.723
取栓次数[次，M（Q₁，Q₃）]	2（1，3）	2（1，3）	Z=-0.439	0.661
取栓技术[例（%）]			χ²=5.613	0.018
支架取栓	56（88.89）	237（75.24）
抽吸取栓	7（11.11）	78（24.76）
mTICI[例（%）]
≥2b级	51（80.95）	268（85.08）	χ²=0.679	0.410
3级	30（47.62）	173（54.92）	χ²=1.126	0.289
90 d mRS评分[例（%）]			χ²=5.139	0.023
0~2分	43（68.25）	166（52.70）
≥3分	20（31.75）	149（47.30）
症状性颅内出血[例（%）]	5（7.94）	31（9.84）	χ²=0.221	0.638

项目	血栓迁移组（n=63）	血栓稳定组（n=315）	统计值	P值
年龄（岁， $x ¯$ ±s）	66.52±12.49	65.32±13.68	t=0.645	0.520
男性[例（%）]	36（57.14）	191（60.63）	χ²=0.267	0.605
既往史[例（%）]
脑卒中或TIA	4（6.35）	24（7.62）	χ²=0.008	0.930
高血压	41（65.08）	183（58.10）	χ²=1.061	0.303
糖尿病	18（28.57）	96（30.48）	χ²=0.090	0.764
高脂血症	9（14.29）	50（15.87）	χ²=0.100	0.751
心房颤动	24（38.10）	156（49.52）	χ²=2.749	0.097
基线NIHSS评分（分， $x ¯$ ±s）	16.73±7.25	17.63±6.38	t=0.998	0.319
基线ASPECTS（分， $x ¯$ ±s）	7.76±1.04	7.68±1.11	t=0.528	0.598
TOAST病因分型[例（%）]			χ²=4.739	0.030
非心源性栓塞型	43（68.25）	168（53.33）
心源性栓塞型	20（31.75）	147（46.67）
CTA血栓位置[例（%）]			χ²=1.193	0.551
颈内动脉	16（25.40）	102（32.38）
大脑中动脉	45（71.43）	204（64.76）
大脑前动脉	2（3.17）	9（2.86）
rt-PA静脉溶栓[例（%）]	31（49.21）	90（28.57）	χ²=10.271	0.001
时间节段[min，M（Q₁，Q₃）]
CTA至首次DSA时间	58（48，69）	61（50，72）	Z=-1.369	0.135
发病至股动脉穿刺时间	211（153，333）	223（156，328）	Z=-0.195	0.842
穿刺至血管再通时间	60（50，65）	50（35，85）	Z=-0.354	0.723
取栓次数[次，M（Q₁，Q₃）]	2（1，3）	2（1，3）	Z=-0.439	0.661
取栓技术[例（%）]			χ²=5.613	0.018
支架取栓	56（88.89）	237（75.24）
抽吸取栓	7（11.11）	78（24.76）
mTICI[例（%）]
≥2b级	51（80.95）	268（85.08）	χ²=0.679	0.410
3级	30（47.62）	173（54.92）	χ²=1.126	0.289
90 d mRS评分[例（%）]			χ²=5.139	0.023
0~2分	43（68.25）	166（52.70）
≥3分	20（31.75）	149（47.30）
症状性颅内出血[例（%）]	5（7.94）	31（9.84）	χ²=0.221	0.638

变量	β值	SE值	Wald χ²值	OR值	95%CI	P值
年龄	0.004	0.011	0.149	1.004	0.984~1.025	0.699
基线NIHSS评分	-0.026	0.023	1.282	0.975	0.932~1.019	0.258
TOAST病因分型
非心源性栓塞型（参考组）	-	-	-	1.000	-	-
心源性栓塞型	-0.611	0.299	4.192	0.543	0.302~0.974	0.041
CTA血栓位置
颈内动脉（参考组）	-	-	-	1.000	-	-
大脑中动脉	0.262	0.323	0.660	1.300	0.690~2.448	0.416
大脑前动脉	0.298	0.852	0.122	1.347	0.254~7.146	0.727
rt-PA静脉溶栓	0.885	0.287	9.530	2.424	1.382~4.252	0.002
发病至股动脉穿刺时间	0.000	0.002	0.080	1.000	0.997~1.003	0.777

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