Santos Emilie M M, Dankbaar Jan Willem, Treurniet Kilian M, Horsch Alexander D, Roos Yvo B, Kappelle L Jaap, Niessen Wiro J, Majoie Charles B, Velthuis Birgitta, Marquering Henk A
From the Departments of Radiology (E.M.M.S., K.M.T., C.B.M., H.A.M.), Biomedical Engineering and Physics (E.M.M.S., H.A.M.), and Neurology (Y.B.R.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (E.M.M.S., W.J.N.) and Medical Informatics (E.M.M.S., W.J.N.), Erasmus Medical Center, Rotterdam, The Netherlands; Departments of Radiology (J.W.D., A.D.H., B.V.) and Neurology (L.J.K.), University Medical Centrum Utrecht, Utrecht, The Netherlands; and Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands (W.J.N.).Catharina Hospital, Eindhoven, The NetherlandsCatharina Hospital, Eindhoven, The NetherlandsErasmus Medical Center, Rotterdam, The NetherlandsErasmus Medical Center, Rotterdam, The NetherlandsGelre Hospitals, Apeldoorn, The NetherlandsGelre Hospitals, Apeldoorn, The NetherlandsLeiden University Medical Center, Leiden, The NetherlandsLeiden University Medical Center, Leiden, The NetherlandsMedical Center Haaglanden, The Hague, The NetherlandsMedical Center Haaglanden, The Hague, The NetherlandsOnze Lieve Vrouwe Gasthuis, Amsterdam, The NetherlandsOnze Lieve Vrouwe Gasthuis, Amsterdam, The NetherlandsRadboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsRadboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsRijnstate Hospital, Arnhem, The NetherlandsRijnstate Hospital, Arnhem, The NetherlandsSt. Antonius Hospital, Nieuwegein, The NetherlandsSt. Antonius Hospital, Nieuwegein, The NetherlandsSt. Elisabeth Hospital, Tilburg, The NetherlandsSt. Elisabeth Hospital, Tilburg, The NetherlandsSt. Franciscus Hospital, Rotterdam, The NetherlandsSt. Franciscus Hospital, Rotterdam, The NetherlandsVU Medical Center, Amsterdam, The NetherlandsVU Medical Center, Amsterdam, The NetherlandsUniversity Medical Center Utrecht, Utrecht, The NetherlandsUniversity Medical Center Utrecht, Utrecht, The NetherlandsUniversity Medical Center Utrecht, Utrecht, The NetherlandsUniversity Medical Center Utrech
Stroke. 2016 Aug;47(8):2058-65. doi: 10.1161/STROKEAHA.116.013306. Epub 2016 Jun 23.
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.
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).
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<0.001). In patients with an impervious thrombus, the effect of intravenous r-tPA was not significant (odds ratio, 1.4; 95% confidence interval, 0.5-4.1; P=0.47). Favorable outcome was more common in patients with a pervious thrombi than without (odds ratio, 2.1; 95% confidence interval, 1.3-3.4; P=0.001).
Thrombus perviousness, as measured on computed tomography in the acute stage of ischemic stroke, is strongly associated with recanalization after intravenous r-tPA treatment and with favorable functional outcome.
临床前研究表明，血栓通透性可提高重组组织型纤溶酶原激活剂（r-tPA）的疗效。我们假设，通过放射影像学评估的血栓通透性与静脉注射r-tPA治疗后的再通改善以及更好的功能预后相关。
我们在荷兰急性卒中研究中，对计算机断层血管造影显示颅内动脉闭塞的患者评估了血栓衰减增加（TAI）情况。患者在卒中发作后9小时内纳入研究。将TAI分为可通透或不可通透后，进行逻辑回归分析，以评估静脉注射r-tPA治疗与完全再通以及良好功能预后（改良Rankin量表评分≤2）之间的关联。
308例患者符合纳入标准。TAI的中位数为20.1（四分位间距，8.5 - 37.8）亨氏单位（HU）。我们发现，静脉注射r-tPA治疗的患者，随着TAI增加，完全再通的几率显著增加（P = 0.030）。131个（42%）血栓被分类为TAI≥23 HU的可通透血栓。在有可通透血栓的患者中，静脉注射r-tPA治疗后完全再通比保守治疗更常见（比值比，6.26；95%置信区间，2.4 - 16.8；P < 0.001）。在有不可通透血栓的患者中，静脉注射r-tPA的效果不显著（比值比，1.4；95%置信区间，0.5 - 4.1；P = 0.47）。有可通透血栓的患者比没有的患者更常见良好预后（比值比，2.1；95%置信区间，1.3 - 3.4；P = 0.001）。
在缺血性卒中急性期通过计算机断层扫描测量的血栓可透性，与静脉注射r-tPA治疗后的再通以及良好的功能预后密切相关。
