Permeable Thrombi Are Associated with Higher Intravenous Recombinant Tissue-Type Plasminogen Activator Treatment Success in Patients with Acute Ischemic Stroke

Emilie M M Santos, Jan Willem Dankbaar, Kilian M. Treurniet, Alexander D. Horsch, Yvo B. Roos, L. Jaap Kappelle, Wiro J. Niessen, Charles B. Majoie, Birgitta Velthuis, Henk A. Marquering

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    32 Citations (Scopus)

    Abstract

    Background and Purpose - Preclinical studies showed that thrombus permeability improves recombinant tissue-type plasminogen activator (r-tPA) efficacy. We hypothesize that thrombus permeability estimated from radiological imaging is associated with improved recanalization after treatment with intravenously administered r-tPA (r-tPA) and with better functional outcome. Methods - We assessed thrombus attenuation increase (TAI) in patients from the Dutch Acute Stroke Study with an occlusion of an intracranial artery on computed tomographic angiography. Patients were included within 9 hours after the stroke onset. After dichotomization of TAI as pervious or impervious, logistic regressions analyses were performed to estimate associations of intravenous r-tPA therapy with complete recanalization and with favorable functional outcome (modified Rankin Scale score of ≤2). Results - Three hundred eight patients matched the inclusion criteria. The median TAI was 20.1 (interquartile range, 8.5-37.8) Hounsfield unit (HU). We found a significant increase in the odds of complete recanalization with increasing TAI for patients treated with intravenous r-tPA (P=0.030). One hundred thirty-one (42%) thrombi were classified as pervious with TAI of ≥23 HU. In patients with a pervious thrombus, complete recanalization was more frequent after treatment with intravenous r-tPA than after conservative treatment (odds ratio, 6.26; 95% confidence interval, 2.4-16.8; P

    Original languageEnglish
    Pages (from-to)2058-2065
    JournalStroke
    Volume47
    Issue number8
    DOIs
    Publication statusPublished - 2016

    Keywords

    • angiography
    • permeability
    • reperfusion
    • stroke
    • thrombosis

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