Background: The predictive value of thrombus perviousness in acute ischemic stroke (AIS), as measured by computed tomography (CT), has been intensively studied with conflicting results. In this study, we investigate the predictive potential of the novel concept of dynamic perviousness using three-dimensional (3D) volumetric evaluation of occlusive thrombi. Methods: The full thrombus volume in 65 patients with a hyperdense artery sign on non-contrast CT (NCCT), who underwent mechanical thrombectomy (MT), was segmented. Perviousness maps were computed voxel-wise for the entire thrombus volume as thrombus attenuation increase (TAI) between NCCT and CT angiography (CTA) as well as between CTA and late venous phase CT (CTV). Perviousness was analyzed for its association with NIHSS at admission, Thrombolysis In Cerebral Infarction (TICI) score, and number of MT passes. Results: The mean late-uptake TAI of thrombi with NIHSS scores greater than 21 at admission was approximately 100% higher than for lower scored NIHSS (p between 0.05 and 0.005). Concerning revascularization results, thrombi requiring less than four MT passes had ca. 80% higher group mean late-uptake TAI than clots requiring four or more passes (p = 0.03), and thrombi with TICI score III had ca. 95% higher group mean late-uptake TAI than thrombi with TICI II (p = 0.03). Standard perviousness showed no significant correlation with MT results. Conclusion: Standard thrombus perviousness of 3D clot volume is not associated with revascularization results in AIS. In contrast, dynamic perviousness assessed with a voxel-wise characterization of 3D thrombi volume may be a better predictor of MT outcomes than standard perviousness.
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Univ Virginia Hlth Syst, Dept Neurol Surg, Charlottesville, VA USAUniv Virginia Hlth Syst, Dept Neurol Surg, Charlottesville, VA USA
Dalzell, Christina
Skaff, Anthony
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Univ Virginia Hlth Syst, Dept Neurol Surg, Charlottesville, VA USAUniv Virginia Hlth Syst, Dept Neurol Surg, Charlottesville, VA USA
Skaff, Anthony
Ali, Yusuf
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Univ Virginia Hlth Syst, Dept Neurol Surg, Charlottesville, VA USAUniv Virginia Hlth Syst, Dept Neurol Surg, Charlottesville, VA USA
Ali, Yusuf
Norat, Pedro
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Univ Virginia Hlth Syst, Dept Neurol Surg, Charlottesville, VA USAUniv Virginia Hlth Syst, Dept Neurol Surg, Charlottesville, VA USA
Norat, Pedro
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Yagmurlu, Kaan
Park, Min S.
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Univ Virginia Hlth Syst, Dept Neurol Surg, Charlottesville, VA USAUniv Virginia Hlth Syst, Dept Neurol Surg, Charlottesville, VA USA
Park, Min S.
Kalani, M. Yashar S.
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Univ Oklahoma, Dept Surg, Tulsa, OK USA
St Johns Neurosci Inst, Tulsa, OK USA
Univ Oklahoma, Tulsa, OK 74119 USA
St Johns Neurosci Inst, Tulsa, OK 74119 USAUniv Virginia Hlth Syst, Dept Neurol Surg, Charlottesville, VA USA
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Univ So Calif, Dept Neurol, Los Angeles, CA USA
Rancho Los Amigos Natl Rehabil Ctr, Dept Neurol, Downey, CA USAUniv So Calif, Dept Neurol, Los Angeles, CA USA
Towfighi, Amytis
Markovic, Daniela
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Univ Calif Los Angeles, Dept Biomath, Los Angeles, CA USAUniv So Calif, Dept Neurol, Los Angeles, CA USA
Markovic, Daniela
Ovbiagele, Bruce
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Med Univ S Carolina, Dept Neurosci, Charleston, SC 29425 USAUniv So Calif, Dept Neurol, Los Angeles, CA USA