Seong Hwan Ahn1, Christopher D d'Esterre1, Emmad M Qazi1, Mohammed Najm1, Marta Rubiera1, Enrico Fainardi1, Michael D Hill1, Mayank Goyal1, Andrew M Demchuk1, Ting Y Lee1, Bijoy K Menon2. 1. From the Calgary Stroke Program, Department of Clinical Neurosciences (S.H.A., C.D.d'E., E.M.Q., M.N., M.D.H., M.G., A.M.D., B.K.M.), Department of Radiology (C.D.d'E., M.D.H., M.G., A.M.D., T.Y.L., B.K.M.), Department of Community Health Sciences (M.D.H.), and Seaman Family MR Center (S.H.A., C.D.d'E., E.M.Q., M.N., M.G., A.M.D., B.K.M.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute (M.D.H., M.G., A.M.D., B.K.M.); Department of Neurology, Chosun University School of Medicine, Gwang Ju, South Korea (S.H.A.); Department of Neurology, Hospital Vall d'Hebron, Ps. Vall d'Hebron, Barcelona, Spain (M.R.); Department of Neurosciences and Rehabilitation, University Hospital, Ferrara, Italy (E.F.); and Lawson Health Research Institute and Robarts Research Institute, London, Ontario, Canada (T.Y.L.). 2. From the Calgary Stroke Program, Department of Clinical Neurosciences (S.H.A., C.D.d'E., E.M.Q., M.N., M.D.H., M.G., A.M.D., B.K.M.), Department of Radiology (C.D.d'E., M.D.H., M.G., A.M.D., T.Y.L., B.K.M.), Department of Community Health Sciences (M.D.H.), and Seaman Family MR Center (S.H.A., C.D.d'E., E.M.Q., M.N., M.G., A.M.D., B.K.M.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute (M.D.H., M.G., A.M.D., B.K.M.); Department of Neurology, Chosun University School of Medicine, Gwang Ju, South Korea (S.H.A.); Department of Neurology, Hospital Vall d'Hebron, Ps. Vall d'Hebron, Barcelona, Spain (M.R.); Department of Neurosciences and Rehabilitation, University Hospital, Ferrara, Italy (E.F.); and Lawson Health Research Institute and Robarts Research Institute, London, Ontario, Canada (T.Y.L.). Bijoy.Menon@Albertahealthservices.ca.
Abstract
BACKGROUND AND PURPOSE: Thrombolysis depends on the ability of blood and thrombolytic agents to permeate thrombus. We devised a novel technique to quantify blood permeating through thrombi and determine whether this parameter predicts early recanalization with intravenous tissue-type plasminogen activator. METHODS: Intravenous tissue-type plasminogen activator-treated patients with stroke and complete occlusion on computed tomographic angiography were analyzed using perfusion computed tomography and a delay insensitive algorithm. We generated maps that measure delay in arrival time of contrast within the intracranial arterial tree (T0 maps). A positive sloped regression line of T0 values measured along artery silhouette distal to thrombus was defined as marker of permeable thrombus (occult anterograde flow). Median T0 values at proximal and distal thrombus interface were measured. Early recanalization was assessed on first angiography of subsequent intra-arterial procedure or on a 4-hour computed tomographic angiography. RESULTS: Of 66 patients, occult anterograde flow was detected in 17 (25.8%). Early recanalization was more in patients with occult anterograde flow versus not (66.7 versus 29.7%; P=0.031). Median T0 value (in s) at distal thrombus interface (1.5 versus 3.8; P=0.006) and difference in median T0 value between proximal and distal thrombus interface (1.3 versus 3.7; P=0.014) were less in early recanalizers versus in nonrecanalizers. In multivariable analysis, patients with occult anterograde flow and T0 value difference between proximal and distal thrombus interface ≤2 s recanalized most (71.4%; odds ratio, 12.15; 95% confidence interval, 2.05-71.91), whereas patients with retrograde flow and T0 value difference >2 s recanalized least (25.9%; odds ratio, 1). CONCLUSIONS: Occult anterograde flow through thrombus can be assessed by perfusion computed tomography T0 maps and predicts early recanalization with intravenous tissue-type plasminogen activator robustly.
BACKGROUND AND PURPOSE: Thrombolysis depends on the ability of blood and thrombolytic agents to permeate thrombus. We devised a novel technique to quantify blood permeating through thrombi and determine whether this parameter predicts early recanalization with intravenous tissue-type plasminogen activator. METHODS: Intravenous tissue-type plasminogen activator-treated patients with stroke and complete occlusion on computed tomographic angiography were analyzed using perfusion computed tomography and a delay insensitive algorithm. We generated maps that measure delay in arrival time of contrast within the intracranial arterial tree (T0 maps). A positive sloped regression line of T0 values measured along artery silhouette distal to thrombus was defined as marker of permeable thrombus (occult anterograde flow). Median T0 values at proximal and distal thrombus interface were measured. Early recanalization was assessed on first angiography of subsequent intra-arterial procedure or on a 4-hour computed tomographic angiography. RESULTS: Of 66 patients, occult anterograde flow was detected in 17 (25.8%). Early recanalization was more in patients with occult anterograde flow versus not (66.7 versus 29.7%; P=0.031). Median T0 value (in s) at distal thrombus interface (1.5 versus 3.8; P=0.006) and difference in median T0 value between proximal and distal thrombus interface (1.3 versus 3.7; P=0.014) were less in early recanalizers versus in nonrecanalizers. In multivariable analysis, patients with occult anterograde flow and T0 value difference between proximal and distal thrombus interface ≤2 s recanalized most (71.4%; odds ratio, 12.15; 95% confidence interval, 2.05-71.91), whereas patients with retrograde flow and T0 value difference >2 s recanalized least (25.9%; odds ratio, 1). CONCLUSIONS: Occult anterograde flow through thrombus can be assessed by perfusion computed tomography T0 maps and predicts early recanalization with intravenous tissue-type plasminogen activator robustly.
Authors: D Sacks; B Baxter; B C V Campbell; J S Carpenter; C Cognard; D Dippel; M Eesa; U Fischer; K Hausegger; J A Hirsch; M S Hussain; O Jansen; M V Jayaraman; A A Khalessi; B W Kluck; S Lavine; P M Meyers; S Ramee; D A Rüfenacht; C M Schirmer; D Vorwerk Journal: AJNR Am J Neuroradiol Date: 2018-05-17 Impact factor: 3.825
Authors: M A Almekhlafi; W G Kunz; R A McTaggart; M V Jayaraman; M Najm; S H Ahn; E Fainardi; M Rubiera; A V Khaw; A Zini; M D Hill; A M Demchuk; M Goyal; B K Menon Journal: AJNR Am J Neuroradiol Date: 2019-12-05 Impact factor: 3.825
Authors: Won Hyung A Ryu; Michael B Avery; Navjit Dharampal; Isabel E Allen; Steven W Hetts Journal: J Neurointerv Surg Date: 2016-11-09 Impact factor: 5.836
Authors: Henrik Gensicke; James W Evans; Fahad S Al Ajlan; Dar Dowlatshahi; Mohamed Najm; Ana L Calleja; Josep Puig; Sung-lI Sohn; Seong H Ahn; Alexandre Y Poppe; Robert Mikulik; Negar Asdaghi; Thalia S Field; Albert Jin; Talip Asil; Jean-Martin Boulanger; Michael D Hill; Mayank Goyal; Andrew M Demchuk; Bijoy K Menon Journal: Neuroradiology Date: 2019-11-12 Impact factor: 2.804
Authors: Michael V Mazya; Charith Cooray; Kennedy R Lees; Danilo Toni; Gary A Ford; Michal Bar; Senta Frol; Tiago Moreira; Lakshmanan Sekaran; Viktor Švigelj; Nils Wahlgren; Niaz Ahmed Journal: Eur Stroke J Date: 2017-11-29
Authors: E M M Santos; C D d'Esterre; K M Treurniet; W J Niessen; M Najm; M Goyal; A M Demchuk; C B Majoie; B K Menon; H A Marquering Journal: Neuroradiology Date: 2017-09-30 Impact factor: 2.804