Abstract
Thrombus perviousness is strongly associated with functional outcome and intravenous alteplase treatment success in patients with acute ischemic stroke. Accuracy of thrombus attenuation increase (TAI) assessment may be compromised by a heterogeneous thrombus composition and interobserver variations of currently used manual measurements. We hypothesized that TAI is more strongly associated with clinical outcomes when evaluated on the entire thrombus.In 195 patients, five TAI measures were performed: one manual by placing three regions of interest (TAImanual) and four automated ones assessing densities from the entire thrombus. The automated TAI measures were calculated by comparing quartiles; Q1, Q2, and Q3 of the non-contrast and contrast enhanced thrombus density distribution and using the lag of the maximum of the cross correlations (MCC). Associations with functional outcome (mRS at 90 days) were assessed with univariate and multivariable analyses.All entire TAI measures were significantly associated with functional outcome with odd ratios (OR) of 1.63(95 %CI:1.19–2.25, p = 0.003) for Q1, 1.56(95 %CI:1.16–2.10, p = 0.003) for Q2, 1.24(95 %CI:1.00–1.54, p = 0.045) for Q3, and 1.70(95 %CI:1.24–2.34, p = 0.001) for MCC per 10 HU increase in univariate models. TAImanual was not significantly associated with functional outcome (p = 0.055). In the multivariable logistic regression models including age, NIHSS, and recanalization, only TAI measures derived from the entire thrombus were independently associated with favorable outcome; OR of 1.64(95 %CI:1.01–2.66, p = 0.048) for Q2 and 1.82(1.13–2.95, p = 0.014) for MCC per 10 HU increase of thrombus attenuation.The novel perviousness measures of the entire thrombus are more strongly associated with functional outcome than the traditional manual perviousness assessments.
Highlights
All baseline and outcome characteristics, their descriptive analysis, and their associa tions with thrombus attenuation increase (TAI) and favorable outcome are presented in Supplemental Table 1
This study shows that, compared to TAI derived from manually selected regions, novel TAI measures derived from full thrombus seg mentation are more strongly associated with functional outcome, as well as with follow-up recanalization in patients receiving best medical treatment with intravenous alteplase if eligible
The lowest Akaike information criterion (AIC) and Bayesian information criterion (BIC) and highest association with favorable outcome and recanalization was found for the cross correlation of Computer Tomog raphy Angiography (CTA) and non-contrast Computer Tomography (NCCT) densities distributions derived over the entire thrombus
Summary
Thrombus perviousness derived from admission imaging is strongly associated with outcome of acute ischemic stroke treatment (Ahn et al, 2015; Borst et al, 2017; Dutra et al, 2019; Frolich et al, 2012; Kap pelhof et al, 2021; Santos et al, 2016b, 2016a). Thrombus perviousness is determined by the estimation of the level of contrast penetration in a thrombus on radiological imaging (Ahn et al, 2015; Dutra et al, 2019; Kappelhof et al, 2021; Labiche et al, 2003; Santos et al, 2016b, 2016a). Previous research has shown that thrombus perviousness is related to thrombus histology (Benson et al, 2020; Berndt et al, 2018; Patel et al, 2021), and that histology is related to the mechanical behavior of thrombi such as fracture, stiffness, or contrac tion (Fereidoonnezhad et al, 2020; Gunning et al, 2018; Johnson et al, 2020, 2017; Tutwiler et al, 2017). To our knowledge, no study directly relates thrombus perviousness to mechanical behavior of thrombi
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