From the Department of Neurology (J.Y., J.-H.B., H.P., D.S., K.K., I.G.H., Y.D.K., K.-Y.L., H.S.N., J.H.H.).
Yonsei University College of Medicine, Seoul, Korea; Department of Neurology, Keimyung University School of Medicine, Daegu, Korea (J.Y.).
Stroke. 2018 Sep;49(9):2108-2115. doi: 10.1161/STROKEAHA.118.021864.
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 mm; 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 mm. In the prospective multicenter validation study, none of the patients with a thrombus volume ≥200 mm 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.
背景与目的- 我们研究了测量血栓体积和密度是否可以预测静脉溶栓后再通失败。方法- 本研究包括一项回顾性队列研究，旨在开发一种基于计算机断层扫描的血栓标志物，以预测静脉溶栓后再通失败，并通过前瞻性多中心队列进行验证。使用 3 维软件对基线薄层非增强计算机断层扫描（1 或 1.25mm）进行半自动化测量血栓的体积和密度。在接受进一步动脉内治疗的患者中，在静脉溶栓后立即进行计算机断层血管造影或磁共振血管造影，评估再通情况。非再通定义为改良脑梗死溶栓分级 0、1、2a。结果- 在回顾性队列中，214 例患者中有 162 例（76.7%）未能实现再通。非再通患者的血栓体积明显大于再通患者（149.5±127.6 与 65.3±58.3mm；P<0.001）。在多变量分析中，血栓体积与非再通独立相关（P<0.001）。预测非再通的截止值计算为 200mm。在前瞻性多中心验证研究中，78 例入组患者中，无一例血栓体积≥200mm 的患者实现再通成功。在回顾性队列中，阳性和阴性预测值分别为 95.5%和 29.4%，在前瞻性验证队列中，阳性和阴性预测值分别为 100%和 23.3%。血栓密度与非再通无关。结论- 血栓体积是静脉溶栓后再通失败的预测因素。血栓体积的测量可能有助于确定再通策略，并可能识别适合直接血管内血栓切除术的患者。
