BACKGROUND: In stroke erythrocyte-rich thrombi are more sensitive to intravenous thrombolysis with recombinant tissue plasminogen activator (IV-rtPA) and have higher density on non-contrast CT (NCCT). We investigated the relationship between thrombus density and recanalization and whether persistent occlusions can be predicted by Hounsfield unit (HU) measurements. METHODS: In 88 IV-rtPA-treated patients with intracranial ICA or MCA occluding thrombus and follow-up imaging, thrombus and contralateral vessel attenuation measurements were performed on thin-slice NCCT. Mean absolute and relative HU were compared between patients with persistent occlusion (modified Thrombolysis in Cerebral Infarction system, grade 0/1/2a) and recanalization (grade 2b/3). Univariate and multivariate (adjusted for stroke subtype, clot burden score, occlusion site and time to thrombolysis) odds ratios for persistent occlusion were calculated. Additional prognostic value for persistent occlusion was estimated by adding HU measurements to the area under the curve (AUC) of known determinants and calculating optimal cut-off values. RESULTS: Patients with persistent occlusion (n = 19) had significant lower mean HU (absolute 52.2 ± 9.5, relative 1.29 ± 0.20) compared to recanalization (absolute 63.1 ± 10.7, relative 1.54 ± 0.23, both p < 0.0001). Odds ratios for persistent occlusion were 3.1 (95% confidence interval, CI 1.6-6.0) univariate and 3.1 (95% CI 1.7-5.7) multivariate per 10 absolute HU decrease and 3.2 (95% CI 1.6-6.5) univariate and 4.1 (95% CI 1.8-9.1) multivariate per 0.20 relative HU decrease. Attenuation measurements significantly increased the AUC (0.67) of the known determinants to 0.84 (absolute HU) and 0.86 (relative HU). Cut-off values of <56.5 absolute HU and <1.38 relative HU showed optimal predictive values for persistent occlusion. CONCLUSIONS: Thrombus density is related to recanalization rate. Lower absolute and relative HU are independently related to persistent occlusion and HU measurements significantly increase discriminative performances of known recanalization determinants.
BACKGROUND: In stroke erythrocyte-rich thrombi are more sensitive to intravenous thrombolysis with recombinant tissue plasminogen activator (IV-rtPA) and have higher density on non-contrast CT (NCCT). We investigated the relationship between thrombus density and recanalization and whether persistent occlusions can be predicted by Hounsfield unit (HU) measurements. METHODS: In 88 IV-rtPA-treated patients with intracranial ICA or MCA occluding thrombus and follow-up imaging, thrombus and contralateral vessel attenuation measurements were performed on thin-slice NCCT. Mean absolute and relative HU were compared between patients with persistent occlusion (modified Thrombolysis in Cerebral Infarction system, grade 0/1/2a) and recanalization (grade 2b/3). Univariate and multivariate (adjusted for stroke subtype, clot burden score, occlusion site and time to thrombolysis) odds ratios for persistent occlusion were calculated. Additional prognostic value for persistent occlusion was estimated by adding HU measurements to the area under the curve (AUC) of known determinants and calculating optimal cut-off values. RESULTS:Patients with persistent occlusion (n = 19) had significant lower mean HU (absolute 52.2 ± 9.5, relative 1.29 ± 0.20) compared to recanalization (absolute 63.1 ± 10.7, relative 1.54 ± 0.23, both p < 0.0001). Odds ratios for persistent occlusion were 3.1 (95% confidence interval, CI 1.6-6.0) univariate and 3.1 (95% CI 1.7-5.7) multivariate per 10 absolute HU decrease and 3.2 (95% CI 1.6-6.5) univariate and 4.1 (95% CI 1.8-9.1) multivariate per 0.20 relative HU decrease. Attenuation measurements significantly increased the AUC (0.67) of the known determinants to 0.84 (absolute HU) and 0.86 (relative HU). Cut-off values of <56.5 absolute HU and <1.38 relative HU showed optimal predictive values for persistent occlusion. CONCLUSIONS:Thrombus density is related to recanalization rate. Lower absolute and relative HU are independently related to persistent occlusion and HU measurements significantly increase discriminative performances of known recanalization determinants.
Authors: Waleed Brinjikji; Sharon Duffy; Anthony Burrows; Werner Hacke; David Liebeskind; Charles B L M Majoie; Diederik W J Dippel; Adnan H Siddiqui; Pooja Khatri; Blaise Baxter; Raul Nogeuira; Matt Gounis; Tudor Jovin; David F Kallmes Journal: J Neurointerv Surg Date: 2016-05-10 Impact factor: 5.836
Authors: Chadi Zemzemi; Matthew Phillips; Deborah C Vela; Nicole A Hilvert; John M Racadio; Kenneth B Bader; Kevin J Haworth; Christy K Holland Journal: Ultrasound Med Biol Date: 2022-05-26 Impact factor: 3.694
Authors: Tetsuya Hashimoto; Takenobu Kunieda; Tristan Honda; Fabien Scalzo; Latisha K Sharma; Jason D Hinman; Neal M Rao; May Nour; Mersedeh Bahr-Hosseini; Jeffrey L Saver; Radoslav Raychev; David S Liebeskind Journal: Neuroradiol J Date: 2021-10-05
Authors: Jan W Dankbaar; Henri P Bienfait; Coen van den Berg; Edwin Bennink; Alexander D Horsch; Tom van Seeters; Irene C van der Schaaf; L Jaap Kappelle; Birgitta K Velthuis Journal: Cerebrovasc Dis Date: 2018-05-17 Impact factor: 2.762
Authors: Emilie M M Santos; Wiro J Niessen; Albert J Yoo; Olvert A Berkhemer; Ludo F Beenen; Charles B Majoie; Henk A Marquering Journal: PLoS One Date: 2016-01-14 Impact factor: 3.240
Authors: Grant Mair; Rüdiger von Kummer; Zoe Morris; Anders von Heijne; Nick Bradey; Lesley Cala; André Peeters; Andrew J Farrall; Alessandro Adami; Gillian Potter; Geoff Cohen; Peter A G Sandercock; Richard I Lindley; Joanna M Wardlaw Journal: Neurology Date: 2015-12-09 Impact factor: 9.910
Authors: Grant Mair; Rüdiger von Kummer; Richard I Lindley; Peter A G Sandercock; Joanna M Wardlaw Journal: PLoS One Date: 2015-12-23 Impact factor: 3.240