Letter by Wu et al Regarding Article, "Thrombus Volume as a Predictor of Nonrecanalization After Intravenous Thrombolysis in Acute Stroke".

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HomeStrokeVol. 50, No. 1Letter by Wu et al Regarding Article, “Thrombus Volume as a Predictor of Nonrecanalization After Intravenous Thrombolysis in Acute Stroke” Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter by Wu et al Regarding Article, “Thrombus Volume as a Predictor of Nonrecanalization After Intravenous Thrombolysis in Acute Stroke” Di Wu, PhD, Yuchuan Ding, MD, PhD and Xunming Ji, MD, PhD Di WuDi Wu China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China Search for more papers by this author , Yuchuan DingYuchuan Ding China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China Search for more papers by this author and Xunming JiXunming Ji China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China Search for more papers by this author Originally published7 Dec 2018https://doi.org/10.1161/STROKEAHA.118.023527Stroke. 2019;50:e16Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: December 7, 2018: Ahead of Print To the Editor:We read with interest the recent article by Yoo et al,1 which aimed to investigate the volume and density of a thrombus for predicting nonrecanalization after intravenous thrombolysis. Interestingly, they found that the patients with nonrecanalization had a larger thrombus volume than those with successful recanalization, thrombus volume independently associated with nonrecanalization in the multivariate analysis, and then a cutoff for predicting nonrecanalization. In the further prospective multicenter validation study, none of the patients with a thrombus volume above the cutoff value achieved successful recanalization. However, different studies reported various predicting associations about thrombus characteristics (volume, length, density, or perviousness) and recanalization in intravenous thrombolysis.2–4We firstly commend the authors for their work. However, a few of the results warrant closer inspection. Nonrecanalization rates were different among these studies.2–4 For example, only 55.1% patients did not achieve reperfusion in stroke patients with large-vessel occlusion.3 However, ≈80% patients failed to achieve recanalization in the study by Yoo et al.1 In addition, there were a lower percentage of patients with large artery atherosclerosis and a higher percentage of cardioembolism patients (>50%) in both retrospective and prospective studies.1 Therefore, patient composition in this study was different from the TOAST study (Trial of ORG 10172 in Acute Stroke Treatment), in which cardioembolus accounted for ≈25% of all patients. Stroke patients because of cardioembolism had some special clinical characteristics, including a larger clot, a special composition, and a lower thrombolysis rate when compared with stroke patients of other subtypes.5 So, the higher percentage of cardioembolism may have an influence on clot volume and density and final recanalization of intravenous thrombolysis.In conclusion, measurement of thrombus volume may help identify patients because of cardioembolism for direct endovascular thrombectomy.Di Wu, PhDYuchuan Ding, MD, PhDXunming Ji, MD, PhDChina-America Institute of NeuroscienceXuanwu Hospital, Capital Medical UniversityBeijing, ChinaSources of FundingDr Wu is supported by National Natural Science Foundation of China (81500997, 81871022).DisclosuresNone.FootnotesStroke welcomes Letters to the Editor and will publish them, if suitable, as space permits. Letters must reference a Stroke published-ahead-of-print article or an article printed within the past 4 weeks. The maximum length is 750 words including no more than 5 references and 3 authors. Please submit letters typed double-spaced. Letters may be shortened or edited.Guest Editor for this article was Michael Brainin, MD, FESO, FAHA.