Thrombus Volume as a Predictor of Nonrecanalization After Intravenous Thrombolysis in Acute Stroke

Joonsang Yoo, Jang Hyun Baek, Hyungjong Park, Dongbeom Song, Kyoungsub Kim, In Gun Hwang, Young Dae Kim, Seo Hyun Kim, Hye Sun Lee, Seong Hwan Ahn, Han Jin Cho, Gyu Sik Kim, Jinkwon Kim, Kyung Yul Lee, Tae Jin Song, Hye Yeon Choi, Hyo Suk Nam, Jihoe Heo

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background and Purpose- We investigated whether measuring the volume and density of a thrombus could predict nonrecanalization after intravenous thrombolysis. Methods- This study included a retrospective cohort to develop a computed tomography marker of thrombus for predicting nonrecanalization after intravenous thrombolysis and a prospective multicenter cohort for validation of this marker. The volume and density of thrombus were measured semiautomatically using 3-dimensional software on a baseline thin-section noncontrast computed tomography (1 or 1.25 mm). Recanalization was assessed on computed tomography angiography or magnetic resonance angiography immediately after intravenous thrombolysis or conventional angiography in patients who underwent further intra-arterial treatment. Nonrecanalization was defined as a modified Thrombolysis in Cerebral Infarction grade 0, 1, 2a. Results- In the retrospective cohort, 162 of 214 patients (76.7%) failed to achieve recanalization. The thrombus volume was significantly larger in patients with nonrecanalization than in those with successful recanalization (149.5±127.6 versus 65.3±58.3 mm3; P<0.001). In the multivariate analysis, thrombus volume was independently associated with nonrecanalization ( P<0.001). The cutoff for predicting nonrecanalization was calculated as 200 mm3. In the prospective multicenter validation study, none of the patients with a thrombus volume ≥200 mm3 among 78 enrolled patients achieved successful recanalization. The positive and negative predictive values were 95.5 and 29.4 in the retrospective cohort 100 and 23.3 in the prospective validation cohort, respectively. The thrombus density was not associated with nonrecanalization. Conclusions- Thrombus volume was predictive of nonrecanalization after intravenous thrombolysis. Measurement of thrombus volume may help in determining the recanalization strategy and perhaps identify patients suitable for direct endovascular thrombectomy.

Original languageEnglish
Pages (from-to)2108-2115
Number of pages8
JournalStroke
Volume49
Issue number9
DOIs
Publication statusPublished - 2018 Sep 1

Fingerprint

Thrombosis
Stroke
Tomography
Thrombectomy
Magnetic Resonance Angiography
Validation Studies
Cerebral Infarction
Multicenter Studies
Angiography
Software
Multivariate Analysis

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing

Cite this

Yoo, Joonsang ; Baek, Jang Hyun ; Park, Hyungjong ; Song, Dongbeom ; Kim, Kyoungsub ; Hwang, In Gun ; Kim, Young Dae ; Kim, Seo Hyun ; Lee, Hye Sun ; Ahn, Seong Hwan ; Cho, Han Jin ; Kim, Gyu Sik ; Kim, Jinkwon ; Lee, Kyung Yul ; Song, Tae Jin ; Choi, Hye Yeon ; Nam, Hyo Suk ; Heo, Jihoe. / Thrombus Volume as a Predictor of Nonrecanalization After Intravenous Thrombolysis in Acute Stroke. In: Stroke. 2018 ; Vol. 49, No. 9. pp. 2108-2115.
@article{e988a6b6c69248fabaca835e8db957a4,
title = "Thrombus Volume as a Predictor of Nonrecanalization After Intravenous Thrombolysis in Acute Stroke",
abstract = "Background and Purpose- We investigated whether measuring the volume and density of a thrombus could predict nonrecanalization after intravenous thrombolysis. Methods- This study included a retrospective cohort to develop a computed tomography marker of thrombus for predicting nonrecanalization after intravenous thrombolysis and a prospective multicenter cohort for validation of this marker. The volume and density of thrombus were measured semiautomatically using 3-dimensional software on a baseline thin-section noncontrast computed tomography (1 or 1.25 mm). Recanalization was assessed on computed tomography angiography or magnetic resonance angiography immediately after intravenous thrombolysis or conventional angiography in patients who underwent further intra-arterial treatment. Nonrecanalization was defined as a modified Thrombolysis in Cerebral Infarction grade 0, 1, 2a. Results- In the retrospective cohort, 162 of 214 patients (76.7{\%}) failed to achieve recanalization. The thrombus volume was significantly larger in patients with nonrecanalization than in those with successful recanalization (149.5±127.6 versus 65.3±58.3 mm3; P<0.001). In the multivariate analysis, thrombus volume was independently associated with nonrecanalization ( P<0.001). The cutoff for predicting nonrecanalization was calculated as 200 mm3. In the prospective multicenter validation study, none of the patients with a thrombus volume ≥200 mm3 among 78 enrolled patients achieved successful recanalization. The positive and negative predictive values were 95.5 and 29.4 in the retrospective cohort 100 and 23.3 in the prospective validation cohort, respectively. The thrombus density was not associated with nonrecanalization. Conclusions- Thrombus volume was predictive of nonrecanalization after intravenous thrombolysis. Measurement of thrombus volume may help in determining the recanalization strategy and perhaps identify patients suitable for direct endovascular thrombectomy.",
author = "Joonsang Yoo and Baek, {Jang Hyun} and Hyungjong Park and Dongbeom Song and Kyoungsub Kim and Hwang, {In Gun} and Kim, {Young Dae} and Kim, {Seo Hyun} and Lee, {Hye Sun} and Ahn, {Seong Hwan} and Cho, {Han Jin} and Kim, {Gyu Sik} and Jinkwon Kim and Lee, {Kyung Yul} and Song, {Tae Jin} and Choi, {Hye Yeon} and Nam, {Hyo Suk} and Jihoe Heo",
year = "2018",
month = "9",
day = "1",
doi = "10.1161/STROKEAHA.118.021864",
language = "English",
volume = "49",
pages = "2108--2115",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "9",

}

Yoo, J, Baek, JH, Park, H, Song, D, Kim, K, Hwang, IG, Kim, YD, Kim, SH, Lee, HS, Ahn, SH, Cho, HJ, Kim, GS, Kim, J, Lee, KY, Song, TJ, Choi, HY, Nam, HS & Heo, J 2018, 'Thrombus Volume as a Predictor of Nonrecanalization After Intravenous Thrombolysis in Acute Stroke', Stroke, vol. 49, no. 9, pp. 2108-2115. https://doi.org/10.1161/STROKEAHA.118.021864

Thrombus Volume as a Predictor of Nonrecanalization After Intravenous Thrombolysis in Acute Stroke. / Yoo, Joonsang; Baek, Jang Hyun; Park, Hyungjong; Song, Dongbeom; Kim, Kyoungsub; Hwang, In Gun; Kim, Young Dae; Kim, Seo Hyun; Lee, Hye Sun; Ahn, Seong Hwan; Cho, Han Jin; Kim, Gyu Sik; Kim, Jinkwon; Lee, Kyung Yul; Song, Tae Jin; Choi, Hye Yeon; Nam, Hyo Suk; Heo, Jihoe.

In: Stroke, Vol. 49, No. 9, 01.09.2018, p. 2108-2115.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Thrombus Volume as a Predictor of Nonrecanalization After Intravenous Thrombolysis in Acute Stroke

AU - Yoo, Joonsang

AU - Baek, Jang Hyun

AU - Park, Hyungjong

AU - Song, Dongbeom

AU - Kim, Kyoungsub

AU - Hwang, In Gun

AU - Kim, Young Dae

AU - Kim, Seo Hyun

AU - Lee, Hye Sun

AU - Ahn, Seong Hwan

AU - Cho, Han Jin

AU - Kim, Gyu Sik

AU - Kim, Jinkwon

AU - Lee, Kyung Yul

AU - Song, Tae Jin

AU - Choi, Hye Yeon

AU - Nam, Hyo Suk

AU - Heo, Jihoe

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Background and Purpose- We investigated whether measuring the volume and density of a thrombus could predict nonrecanalization after intravenous thrombolysis. Methods- This study included a retrospective cohort to develop a computed tomography marker of thrombus for predicting nonrecanalization after intravenous thrombolysis and a prospective multicenter cohort for validation of this marker. The volume and density of thrombus were measured semiautomatically using 3-dimensional software on a baseline thin-section noncontrast computed tomography (1 or 1.25 mm). Recanalization was assessed on computed tomography angiography or magnetic resonance angiography immediately after intravenous thrombolysis or conventional angiography in patients who underwent further intra-arterial treatment. Nonrecanalization was defined as a modified Thrombolysis in Cerebral Infarction grade 0, 1, 2a. Results- In the retrospective cohort, 162 of 214 patients (76.7%) failed to achieve recanalization. The thrombus volume was significantly larger in patients with nonrecanalization than in those with successful recanalization (149.5±127.6 versus 65.3±58.3 mm3; P<0.001). In the multivariate analysis, thrombus volume was independently associated with nonrecanalization ( P<0.001). The cutoff for predicting nonrecanalization was calculated as 200 mm3. In the prospective multicenter validation study, none of the patients with a thrombus volume ≥200 mm3 among 78 enrolled patients achieved successful recanalization. The positive and negative predictive values were 95.5 and 29.4 in the retrospective cohort 100 and 23.3 in the prospective validation cohort, respectively. The thrombus density was not associated with nonrecanalization. Conclusions- Thrombus volume was predictive of nonrecanalization after intravenous thrombolysis. Measurement of thrombus volume may help in determining the recanalization strategy and perhaps identify patients suitable for direct endovascular thrombectomy.

AB - Background and Purpose- We investigated whether measuring the volume and density of a thrombus could predict nonrecanalization after intravenous thrombolysis. Methods- This study included a retrospective cohort to develop a computed tomography marker of thrombus for predicting nonrecanalization after intravenous thrombolysis and a prospective multicenter cohort for validation of this marker. The volume and density of thrombus were measured semiautomatically using 3-dimensional software on a baseline thin-section noncontrast computed tomography (1 or 1.25 mm). Recanalization was assessed on computed tomography angiography or magnetic resonance angiography immediately after intravenous thrombolysis or conventional angiography in patients who underwent further intra-arterial treatment. Nonrecanalization was defined as a modified Thrombolysis in Cerebral Infarction grade 0, 1, 2a. Results- In the retrospective cohort, 162 of 214 patients (76.7%) failed to achieve recanalization. The thrombus volume was significantly larger in patients with nonrecanalization than in those with successful recanalization (149.5±127.6 versus 65.3±58.3 mm3; P<0.001). In the multivariate analysis, thrombus volume was independently associated with nonrecanalization ( P<0.001). The cutoff for predicting nonrecanalization was calculated as 200 mm3. In the prospective multicenter validation study, none of the patients with a thrombus volume ≥200 mm3 among 78 enrolled patients achieved successful recanalization. The positive and negative predictive values were 95.5 and 29.4 in the retrospective cohort 100 and 23.3 in the prospective validation cohort, respectively. The thrombus density was not associated with nonrecanalization. Conclusions- Thrombus volume was predictive of nonrecanalization after intravenous thrombolysis. Measurement of thrombus volume may help in determining the recanalization strategy and perhaps identify patients suitable for direct endovascular thrombectomy.

UR - http://www.scopus.com/inward/record.url?scp=85054347677&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85054347677&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.118.021864

DO - 10.1161/STROKEAHA.118.021864

M3 - Article

C2 - 30354986

AN - SCOPUS:85054347677

VL - 49

SP - 2108

EP - 2115

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 9

ER -