Thrombus Permeability on Dynamic CTA Predicts Good Outcome after Reperfusion Therapy

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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 TAI_max, TAI_peak, and TAI_con, respectively.

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 ± 5	11 ± 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 ± 49.51	40.72 ± 30.91	.001
Baseline hypoperfusion volume (mean) (mL)	134.28 ± 61.07	98.22 ± 60.43	.004
TAI_max (median) (IQR) (HU)	18.0 (10.0–38.7)	39.9 (26.1–73.3)	<.001
TAI_peak (median) (IQR) (HU)	4.6 (−4.2–17.5)	18.7 (5.9–43.0)	<.001
TAI_con (median) (IQR) (HU)	2.2 (−5.5–12.4)	10.4 (−2.0–36.7)	.006
Thrombus perviousness by dichotomized TAI_max (No.) (%)	18 (30.0%)	31 (70.5%)	<.001
Thrombus perviousness by dichotomized TAI_peak (No.) (%)	22 (36.7%)	31 (70.5%)	.001
Thrombus perviousness by dichotomized TAI_con (No.) (%)	13 (21.7%)	21 (47.7%)	.005

Table 2:

Multivariable regression for good outcome

	OR	95% CI	P Value
Model 1
Age	0.966	0.926–1.008	.114
Baseline NIHSS	0.911	0.823–1.008	.071
Atrial fibrillation	0.872	0.298–2.555	.803
ONT	0.992	0.987–0.997	.004
Baseline infarct core volume	0.986	0.972–1.001	.061
Thrombus perviousness by dichotomized TAI_max	3.957	1.463–10.705	.007
Model 2
Age	0.963	0.924–1.004	.074
Baseline NIHSS	0.912	0.826–1.006	.066
Atrial fibrillation	0.736	0.260–2.082	.564
ONT	0.992	0.987–0.997	.003
Baseline infarct core volume	0.988	0.974–1.002	.093
Thrombus perviousness by dichotomized TAI_peak	2.887	1.075–7.754	.035
Model 3
Age	0.965	0.926–1.004	.080
Baseline NIHSS	0.917	0.827–1.016	.098
Atrial fibrillation	0.751	0.269–2.102	.586
ONT	0.992	0.987–0.997	.003
Baseline infarct core volume	0.986	0.972–1.000	.050
Thrombus perviousness by dichotomized TAI_con	2.323	0.815–6.621	.115