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Research ArticleNeurointervention
Open Access

Thrombus Permeability on Dynamic CTA Predicts Good Outcome after Reperfusion Therapy

Z. Chen, F. Shi, X. Gong, R. Zhang, W. Zhong, R. Zhang, Y. Zhou and M. Lou
American Journal of Neuroradiology October 2018, 39 (10) 1854-1859; DOI: https://doi.org/10.3174/ajnr.A5785
Z. Chen
aFrom the Department of Neurology (Z.C., F.S., X.G., R.Z., W.Z., R.Z., Y.Z., M.L.), Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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F. Shi
aFrom the Department of Neurology (Z.C., F.S., X.G., R.Z., W.Z., R.Z., Y.Z., M.L.), Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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X. Gong
aFrom the Department of Neurology (Z.C., F.S., X.G., R.Z., W.Z., R.Z., Y.Z., M.L.), Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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R. Zhang
aFrom the Department of Neurology (Z.C., F.S., X.G., R.Z., W.Z., R.Z., Y.Z., M.L.), Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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W. Zhong
aFrom the Department of Neurology (Z.C., F.S., X.G., R.Z., W.Z., R.Z., Y.Z., M.L.), Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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R. Zhang
aFrom the Department of Neurology (Z.C., F.S., X.G., R.Z., W.Z., R.Z., Y.Z., M.L.), Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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Y. Zhou
aFrom the Department of Neurology (Z.C., F.S., X.G., R.Z., W.Z., R.Z., Y.Z., M.L.), Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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M. Lou
aFrom the Department of Neurology (Z.C., F.S., X.G., R.Z., W.Z., R.Z., Y.Z., M.L.), Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
bZhejiang University Brain Research Institute (M.L.), Hangzhou, Zhejiang, China.
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    Fig 1.

    Illustration of thrombus attenuation increase assessment with 3 ROIs (black circles) measuring the average thrombus attenuations on a left M1 segment of the middle cerebral artery on motion-corrected dynamic CTA. The arterial input function (AIF) curve for all 26 phases was generated (A) and the thrombus permeability was assessed on the CTA images with maximum intensity projection (MIP) in all 26 phases (B), at the mean time delay following intravenous contrast injection in the current study (phase 13) (C), at the arterial peak phase (phase 18) (D), and at the phase with the maximum value (phase 22) (E) of the mean attenuation increase.

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    Fig 2.

    ROC curve of thrombus attenuation increase for TAImax, TAIpeak, and TAIcon, respectively.

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    Table 1:

    Comparison of baseline characteristics according to clinical outcome

    Poor Outcome (mRS > 2) (n = 60)Good Outcome (mRS ≤ 2) (n = 44)P Value
    Age (yr)74 (65–81)66 (58–76).005
    Male (No.) (%)33 (55.0%)28 (63.6%).424
    Baseline NIHSS (mean)16 ± 511 ± 6<.001
    Onset-to-needle time (mean) (min)230 (168–297)207 (119–259).059
    Endovascular thrombectomy (No.) (%)22 (36.7%)16 (36.4%)1.000
    Prior antiplatelet usage (No.) (%)12 (20.0%)9 (20.5%)1.000
    Risk factors
        Smoking (No.) (%)18 (30.0%)13 (29.5%)1.000
        Hypertension (No.) (%)35 (58.3%)22 (50.0%).431
        Diabetes mellitus (No.) (%)16 (26.7%)6 (13.6%).146
        Hyperlipidemia (No.) (%)22 (36.7%)21 (47.7%).315
        History of stroke/TIA (No.) (%)11 (18.3%)5 (11.4%).415
        Atrial fibrillation (No.) (%)38 (63.3%)20 (45.5%).076
    Radiologic data
        Baseline infarct core volume (mean) (mL)69.27 ± 49.5140.72 ± 30.91.001
        Baseline hypoperfusion volume (mean) (mL)134.28 ± 61.0798.22 ± 60.43.004
        TAImax (median) (IQR) (HU)18.0 (10.0–38.7)39.9 (26.1–73.3)<.001
        TAIpeak (median) (IQR) (HU)4.6 (−4.2–17.5)18.7 (5.9–43.0)<.001
        TAIcon (median) (IQR) (HU)2.2 (−5.5–12.4)10.4 (−2.0–36.7).006
        Thrombus perviousness by dichotomized TAImax (No.) (%)18 (30.0%)31 (70.5%)<.001
        Thrombus perviousness by dichotomized TAIpeak (No.) (%)22 (36.7%)31 (70.5%).001
        Thrombus perviousness by dichotomized TAIcon (No.) (%)13 (21.7%)21 (47.7%).005
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    Table 2:

    Multivariable regression for good outcome

    OR95% CIP Value
    Model 1
        Age0.9660.926–1.008.114
        Baseline NIHSS0.9110.823–1.008.071
        Atrial fibrillation0.8720.298–2.555.803
        ONT0.9920.987–0.997.004
        Baseline infarct core volume0.9860.972–1.001.061
        Thrombus perviousness by dichotomized TAImax3.9571.463–10.705.007
    Model 2
        Age0.9630.924–1.004.074
        Baseline NIHSS0.9120.826–1.006.066
        Atrial fibrillation0.7360.260–2.082.564
        ONT0.9920.987–0.997.003
        Baseline infarct core volume0.9880.974–1.002.093
        Thrombus perviousness by dichotomized TAIpeak2.8871.075–7.754.035
    Model 3
        Age0.9650.926–1.004.080
        Baseline NIHSS0.9170.827–1.016.098
        Atrial fibrillation0.7510.269–2.102.586
        ONT0.9920.987–0.997.003
        Baseline infarct core volume0.9860.972–1.000.050
        Thrombus perviousness by dichotomized TAIcon2.3230.815–6.621.115
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American Journal of Neuroradiology: 39 (10)
American Journal of Neuroradiology
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Cite this article
Z. Chen, F. Shi, X. Gong, R. Zhang, W. Zhong, R. Zhang, Y. Zhou, M. Lou
Thrombus Permeability on Dynamic CTA Predicts Good Outcome after Reperfusion Therapy
American Journal of Neuroradiology Oct 2018, 39 (10) 1854-1859; DOI: 10.3174/ajnr.A5785

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Thrombus Permeability on Dynamic CTA Predicts Good Outcome after Reperfusion Therapy
Z. Chen, F. Shi, X. Gong, R. Zhang, W. Zhong, R. Zhang, Y. Zhou, M. Lou
American Journal of Neuroradiology Oct 2018, 39 (10) 1854-1859; DOI: 10.3174/ajnr.A5785
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