Article

Density of Thrombus on Admission CT Predicts Revascularization Efficacy in Large Vessel Occlusion Acute Ischemic Stroke

From Departments of Radiology and Biomedical Imaging, Neurology, and Neurological Surgery, University of California, San Francisco, CA.
Stroke (Impact Factor: 6.02). 10/2012; 44(1). DOI: 10.1161/STROKEAHA.112.674127
Source: PubMed

ABSTRACT BACKGROUND AND PURPOSE: Can lysability of large vessel thrombi in acute ischemic stroke be predicted by measuring clot density on admission nonenhanced CT (NECT), postcontrast enhanced CT, or CT angiogram (CTA)? METHODS: We retrospectively studied 90 patients with acute large vessel ischemic strokes treated with intravenous (IV) tPA, intra-arterial (IA) tPA, and/or mechanical thrombectomy devices. Clot density [in Hounsfield unit (HU)] was measured on NECT, postcontrast enhanced CT, and CTA. Recanalization was assessed by the Thrombolysis in Cerebral Infarction grading system (TICI) on digital subtraction angiography. RESULTS: Thrombus density on preintervention NECT correlated with postintervention TICI grade regardless of pharmacological (IV tPA r=0.69, IA tPA r=0.72, P<0.0001) or mechanical treatment (r=0.73, P<0.0001). Patients with TICI≥2 demonstrated higher HU on NECT (mean corrected HU IV tPA=1.58, IA tPA=1.66, mechanical treatment=1.7) compared with patients with TICI<2 (IV tPA=1.39, IA tPA=1.4, mechanical treatment=1.3) (P=0.01, 0.006, <0.0001 respectively). There was no association between recanalization and age, sex, baseline National Institute of Health Stroke Scale, treatment method, time to treatment, or clot volume. CONCLUSIONS: Thrombi with lower HU on NECT appear to be more resistant to pharmacological lysis and mechanical thrombectomy. Measuring thrombus density on admission NECT provides a rapid method to analyze clot composition, a potentially useful discriminator in selecting the most appropriate reperfusion strategy for an individual patient.

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    • "Resistant thrombi play a pivotal role in the pathogenesis of the conditions associated with thrombotic events like stroke, and recent research by Moftakhar et al. suggests that clot density can potentially be a useful discriminator in selecting the most appropriate reperfusion strategy for an individual patient [3]. It should be noted that the interaction between fibrin fibers and RBCs is also observable in other diseases associated with thrombotic events that precede stroke, such as diabetes mellitus [4]; therefore, this fact suggests a cause and not the consequence of stroke. "
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