Emilie M M Santos1, Jan Willem Dankbaar1, Kilian M Treurniet1, Alexander D Horsch1, Yvo B Roos1, L Jaap Kappelle1, Wiro J Niessen1, Charles B Majoie1, Birgitta Velthuis1, Henk A Marquering1. 1. From the Departments of Radiology (E.M.M.S., K.M.T., C.B.M., H.A.M.), Biomedical Engineering and Physics (E.M.M.S., H.A.M.), and Neurology (Y.B.R.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (E.M.M.S., W.J.N.) and Medical Informatics (E.M.M.S., W.J.N.), Erasmus Medical Center, Rotterdam, The Netherlands; Departments of Radiology (J.W.D., A.D.H., B.V.) and Neurology (L.J.K.), University Medical Centrum Utrecht, Utrecht, The Netherlands; and Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands (W.J.N.).Catharina Hospital, Eindhoven, The NetherlandsCatharina Hospital, Eindhoven, The NetherlandsErasmus Medical Center, Rotterdam, The NetherlandsErasmus Medical Center, Rotterdam, The NetherlandsGelre Hospitals, Apeldoorn, The NetherlandsGelre Hospitals, Apeldoorn, The NetherlandsLeiden University Medical Center, Leiden, The NetherlandsLeiden University Medical Center, Leiden, The NetherlandsMedical Center Haaglanden, The Hague, The NetherlandsMedical Center Haaglanden, The Hague, The NetherlandsOnze Lieve Vrouwe Gasthuis, Amsterdam, The NetherlandsOnze Lieve Vrouwe Gasthuis, Amsterdam, The NetherlandsRadboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsRadboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsRijnstate Hospital, Arnhem, The NetherlandsRijnstate Hospital, Arnhem, The NetherlandsSt. Antonius Hospital, Nieuwegein, The NetherlandsSt. Antonius Hospital, Nieuwegein, The NetherlandsSt. Elisabeth Hospital, Tilburg, The NetherlandsSt. Elisabeth Hospital, Tilburg, The NetherlandsSt. Franciscus Hospital, Rotterdam, The NetherlandsSt. Franciscus Hospital, Rotterdam, The NetherlandsVU Medical Center, Amsterdam, The NetherlandsVU Medical Center, Amsterdam, The NetherlandsUniversity Medical Center Utrecht, Utrecht, The NetherlandsUniversity Medical Center Utrecht, Utrecht, The NetherlandsUniversity Medical Center Utrecht, Utrecht, The NetherlandsUniversity Medical Center Utrech
Abstract
BACKGROUND AND PURPOSE: Preclinical studies showed that thrombus permeability improves recombinant tissue-type plasminogen activator (r-tPA) efficacy. We hypothesize that thrombus permeability estimated from radiological imaging is associated with improved recanalization after treatment with intravenously administered r-tPA (r-tPA) and with better functional outcome. METHODS: We assessed thrombus attenuation increase (TAI) in patients from the Dutch Acute Stroke Study with an occlusion of an intracranial artery on computed tomographic angiography. Patients were included within 9 hours after the stroke onset. After dichotomization of TAI as pervious or impervious, logistic regressions analyses were performed to estimate associations of intravenous r-tPA therapy with complete recanalization and with favorable functional outcome (modified Rankin Scale score of ≤2). RESULTS: Three hundred eight patients matched the inclusion criteria. The median TAI was 20.1 (interquartile range, 8.5-37.8) Hounsfield unit (HU). We found a significant increase in the odds of complete recanalization with increasing TAI for patients treated with intravenous r-tPA (P=0.030). One hundred thirty-one (42%) thrombi were classified as pervious with TAI of ≥23 HU. In patients with a pervious thrombus, complete recanalization was more frequent after treatment with intravenous r-tPA than after conservative treatment (odds ratio, 6.26; 95% confidence interval, 2.4-16.8; P<0.001). In patients with an impervious thrombus, the effect of intravenous r-tPA was not significant (odds ratio, 1.4; 95% confidence interval, 0.5-4.1; P=0.47). Favorable outcome was more common in patients with a pervious thrombi than without (odds ratio, 2.1; 95% confidence interval, 1.3-3.4; P=0.001). CONCLUSIONS: Thrombus perviousness, as measured on computed tomography in the acute stage of ischemic stroke, is strongly associated with recanalization after intravenous r-tPA treatment and with favorable functional outcome.
BACKGROUND AND PURPOSE: Preclinical studies showed that thrombus permeability improves recombinant tissue-type plasminogen activator (r-tPA) efficacy. We hypothesize that thrombus permeability estimated from radiological imaging is associated with improved recanalization after treatment with intravenously administered r-tPA (r-tPA) and with better functional outcome. METHODS: We assessed thrombus attenuation increase (TAI) in patients from the Dutch Acute Stroke Study with an occlusion of an intracranial artery on computed tomographic angiography. Patients were included within 9 hours after the stroke onset. After dichotomization of TAI as pervious or impervious, logistic regressions analyses were performed to estimate associations of intravenous r-tPA therapy with complete recanalization and with favorable functional outcome (modified Rankin Scale score of ≤2). RESULTS: Three hundred eight patients matched the inclusion criteria. The median TAI was 20.1 (interquartile range, 8.5-37.8) Hounsfield unit (HU). We found a significant increase in the odds of complete recanalization with increasing TAI for patients treated with intravenous r-tPA (P=0.030). One hundred thirty-one (42%) thrombi were classified as pervious with TAI of ≥23 HU. In patients with a pervious thrombus, complete recanalization was more frequent after treatment with intravenous r-tPA than after conservative treatment (odds ratio, 6.26; 95% confidence interval, 2.4-16.8; P<0.001). In patients with an impervious thrombus, the effect of intravenous r-tPA was not significant (odds ratio, 1.4; 95% confidence interval, 0.5-4.1; P=0.47). Favorable outcome was more common in patients with a pervious thrombi than without (odds ratio, 2.1; 95% confidence interval, 1.3-3.4; P=0.001). CONCLUSIONS:Thrombus perviousness, as measured on computed tomography in the acute stage of ischemic stroke, is strongly associated with recanalization after intravenous r-tPA treatment and with favorable functional outcome.
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