Prediction of thrombus resolution after intravenous thrombolysis assessed by CT-based thrombus imaging

Hyo Suk Nam, Eung Yeop Kim, Seo Hyun Kim, Young Dae Kim, Jinkwon Kim, Hye Sun Lee, Chung Mo Nam, Ji Hoe Heo

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12 Citations (Scopus)

Abstract

The degree of thrombus resolution directly indicates the effectiveness of a thrombolytic drug. We investigated the degree of thrombus resolution and factors associated with thrombus resolution after intravenous (IV) recombinant tissue plasminogen activator (rt-PA) using thin-section noncontrast computed tomography (NCT). Thin-section NCTs were performed before and immediately after IV rt-PA infusion in acute stroke patients. The thrombus volume and Hounsfield unit were measured using three-dimensional imaging software. Immediate recanalisation was assessed immediately after IV rt-PA infusion using CT angiography. During a three-year study period, 130 patients were prospectively enrolled. On baseline thin-section NCT, no thrombi were found in 30 patients (23%). Among the 100 patients with confirmed thrombus, the median volume decreased by 20% on the follow-up NCT. The thrombus was completely resolved in 8%. Of note, an increase in thrombus volume was observed in 20 patients. Independent predictors of thrombus resolution were total rt-PA dose, thrombus location in the M2 segment of the middle cerebral artery, and time from baseline to follow-up NCT. Thrombus resolution increased by 9% per each 10-mg increase in rt-PA (p = 0.045). Immediate complete recanalisation was achieved in 12% of patients. Total dose of rt-PA was independently associated with complete recanalisation [odds ratio [OR] 4.52, 95% confidence interval [CI] 1.345-15.184) and good functional outcome at three months (modified Rankin scale score <3, OR 2.34, 95% CI 1.104-4.962). In conclusion, rt-PA dose was associated with the degree of thrombus resolution, immediate complete recanalisation, and good outcome at three months. CT-based thrombus imaging may be helpful in determining thrombolysis effectiveness.

Original languageEnglish
Pages (from-to)786-794
Number of pages9
JournalThrombosis and Haemostasis
Volume107
Issue number4
DOIs
Publication statusPublished - 2012 Apr 1

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Thrombosis
Tissue Plasminogen Activator
Tomography
Odds Ratio
Confidence Intervals
Fibrinolytic Agents
Three-Dimensional Imaging
Middle Cerebral Artery
Software
Stroke

All Science Journal Classification (ASJC) codes

  • Hematology

Cite this

Nam, Hyo Suk ; Kim, Eung Yeop ; Kim, Seo Hyun ; Kim, Young Dae ; Kim, Jinkwon ; Lee, Hye Sun ; Nam, Chung Mo ; Heo, Ji Hoe. / Prediction of thrombus resolution after intravenous thrombolysis assessed by CT-based thrombus imaging. In: Thrombosis and Haemostasis. 2012 ; Vol. 107, No. 4. pp. 786-794.
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abstract = "The degree of thrombus resolution directly indicates the effectiveness of a thrombolytic drug. We investigated the degree of thrombus resolution and factors associated with thrombus resolution after intravenous (IV) recombinant tissue plasminogen activator (rt-PA) using thin-section noncontrast computed tomography (NCT). Thin-section NCTs were performed before and immediately after IV rt-PA infusion in acute stroke patients. The thrombus volume and Hounsfield unit were measured using three-dimensional imaging software. Immediate recanalisation was assessed immediately after IV rt-PA infusion using CT angiography. During a three-year study period, 130 patients were prospectively enrolled. On baseline thin-section NCT, no thrombi were found in 30 patients (23{\%}). Among the 100 patients with confirmed thrombus, the median volume decreased by 20{\%} on the follow-up NCT. The thrombus was completely resolved in 8{\%}. Of note, an increase in thrombus volume was observed in 20 patients. Independent predictors of thrombus resolution were total rt-PA dose, thrombus location in the M2 segment of the middle cerebral artery, and time from baseline to follow-up NCT. Thrombus resolution increased by 9{\%} per each 10-mg increase in rt-PA (p = 0.045). Immediate complete recanalisation was achieved in 12{\%} of patients. Total dose of rt-PA was independently associated with complete recanalisation [odds ratio [OR] 4.52, 95{\%} confidence interval [CI] 1.345-15.184) and good functional outcome at three months (modified Rankin scale score <3, OR 2.34, 95{\%} CI 1.104-4.962). In conclusion, rt-PA dose was associated with the degree of thrombus resolution, immediate complete recanalisation, and good outcome at three months. CT-based thrombus imaging may be helpful in determining thrombolysis effectiveness.",
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Prediction of thrombus resolution after intravenous thrombolysis assessed by CT-based thrombus imaging. / Nam, Hyo Suk; Kim, Eung Yeop; Kim, Seo Hyun; Kim, Young Dae; Kim, Jinkwon; Lee, Hye Sun; Nam, Chung Mo; Heo, Ji Hoe.

In: Thrombosis and Haemostasis, Vol. 107, No. 4, 01.04.2012, p. 786-794.

Research output: Contribution to journalArticle

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