Quantification of Thrombus Hounsfield Units on Noncontrast CT Predicts Stroke Subtype and Early Recanalization after Intravenous Recombinant Tissue Plasminogen Activator

Puig, Josep; Pedraza, Salvador; Demchuk, Andrew M.; Daunis‐i‐Estadella, Pepus; Termes, H.; Blasco, Gerard; Sòria, Guadalupe; Boada, Imma; Remollo, Sebastián; Banos, Jean-Bruno; Serena, Joaquı́n; Castellanos, Mar

doi:10.3174/ajnr.a2878

Cited by 124 publications

(119 citation statements)

References 36 publications

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“…There is emerging evidence that the success of recanalization efforts is largely driven by the structure of the occluding thrombus 4, 5, 6. Indeed, thrombus perviousness as evidenced by higher clot density is strongly associated with recanalization after intravenous recombinant tissue‐plasminogen activator (rt‐PA) treatment and favorable functional outcome 3.…”

Section: Discussionmentioning

confidence: 99%

“…Understanding the composition of the thrombus may provide additional information to determine the potential success of reperfusion efforts and individual prognosis. Several studies confirmed that a higher thrombus density is associated with improved reperfusion rates and better outcome, regardless of systemic or endovascular recanalization techniques 3, 4, 5, 6. Thrombus density can be determined noninvasively on noncontrast enhanced CT (NECT) and was shown to be dependent on source, time, and hematocrit, and is altered by treatment with antiplatelets 7, 8.…”

Section: Introductionmentioning

confidence: 97%

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Proximal flow to middle cerebral artery is associated with higher thrombus density in terminal internal carotid artery occlusion

Pikija

Magdič

Killer‐Oberpfalzer

et al. 2017

Ann Clin Transl Neurol

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Proximal collaterals may determine the composition of occluding thrombi in acute ischemic stroke (AIS) in addition to source, hematocrit, time, and medication. Here, we performed a retrospective study of 39 consecutive patients with radiological evidence of I‐, L‐, and T‐type terminal internal carotid artery occlusion. Middle cerebral artery (MCA) thrombus density was assessed on noncontrast enhanced CT and proximal collaterals on CT angiography. In patients with presence of proximal collaterals to the MCA we detected more hyperdense clots (P = 0.003) and a higher frequency of leptomeningeal collaterals (P = 0.008). We expand the spectrum of factors that potentially determine clot perviousness and evolution of ischemic stroke.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

Proximal flow to middle cerebral artery is associated with higher thrombus density in terminal internal carotid artery occlusion

Pikija

Magdič

Killer‐Oberpfalzer

et al. 2017

Ann Clin Transl Neurol

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“…It has also been suggested that HMCAS due to cardio-embolism has higher vessel attenuation and is more likely to recanalise post-thrombolysis. 1 Previous angiographic studies show that HMCAS disappearance post-thrombolysis indicates recanalisation of occluded vessels. 10,11 Using HMCAS disappearance as a surrogate for MCA recanalisation, this study aimed to assess predictors of HMCAS disappearance in a realworld group of thrombolysed stroke patients.…”

Section: Introductionmentioning

confidence: 99%

“…1 In one large multicentre study (IST-3) 2 hyperdense arteries were seen in about a quarter of ischaemic strokes, predominantly in the anterior circulation. The presence of HMCAS was associated with worse outcomes but no increased risk of symptomatic haemorrhage following intravenous thrombolysis (IVT).…”

Section: Introductionmentioning

confidence: 99%

“…Disappearance of the HMCAS is more likely following intravenous thrombolysis 3 and is associated with improved outcome. 4 Recent studies suggest that occlusion site, 5 clot length, 6,7 and thrombus Hounsfield Unit (HU) quantification 1,8,9 are all candidates to predict vessel recanalisation after intravenous thrombolysis. It has also been suggested that HMCAS due to cardio-embolism has higher vessel attenuation and is more likely to recanalise post-thrombolysis.…”

Section: Introductionmentioning

confidence: 99%

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Disappearance of the Hyperdense Mca Sign after Stroke Thrombolysis: Implications for Prognosis and Early Patient Selection for Clot Retrieval

Elofuke

Reid

Rana³

et al. 2016

Journal of the Royal College of Physicians of Edinburgh

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Disappearance of the hyperdense middle cerebral artery sign (HMCAS) following intravenous thrombolysis for ischaemic stroke is associated with improved outcome. Debate exists over which radiological thrombus characteristics can predict disappearance of the HMCAS after thrombolysis such as vessel attenuation or extent of thrombus length. Methods Ischaemic stroke patients treated with intravenous thrombolysis from our hospital were entered into a European registry. Patient demographics, stroke severity pre-and 24 hours post-thrombolysis were recorded. Patients with HMCAS were identified from the registry using records from 2010-2013. Images from the pre and post-thrombolysis computed tomography scan were measured. Thrombus characteristics (length and attenuation), extent of ischaemic change and clinical outcome (stroke severity and 3 month survival) were compared between patients with and without HMCAS disappearance. Logistic regression analysis was performed to identify predictors of HMCAS disappearance.Results HMCAS was present in 88/315 (28%) of thrombolysed ischaemic stroke patients. 36/88 (41%) of patients had thrombus disappearance 24 hours after thrombolysis. HMCAS disappearance was associated with reduced stroke severity, less radiological ischaemic change, and higher 3 month survival (87% vs 56%). Median thrombus length was shorter in the HMCAS disappearance group (11 vs 17 mm, p = 0.0004), but no significant difference in vessel attenuation was observed (48 vs 51 Hounsfield Units, p = 0.25). HMCAS disappearance occurred in 73% of cases where HMCAS length was < 10 mm, 38% when length was 10-20 mm, and 21% if > 20 mm. Thrombus length was the only independent predictor of HMCAS disappearance (odds ratio 0.90 per mm; 95% CI 0.84-0.96, p = 0.01). Conclusion Disappearance of HMCAS is associated with better clinical and radiological outcomes. A shorter thrombus is more likely to disappear postthrombolysis. The data highlight the limitation of intravenous thrombolysis in patients with longer hyperattenuated vessels, and the potential role for clot retrieval in such patients.

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Hyperdense middle cerebral artery sign in large cerebral infarction

et al. 2021

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Objectives To evaluate if the hyperdense middle cerebral artery sign (HMCAS) is an imaging biomarker for hemorrhagic transformation (HT) and the functional outcome of patients with large cerebral infarctions without thrombolytic therapy. Materials and Methods The clinical and imaging data of 312 patients with large cerebral infarction without thrombolytic therapy were retrospectively analyzed. They were divided into patients who presented with HMCAS (n = 121) and those who did not (non‐HMCAS[n = 168] patients), and the clinical data of the 2 groups were compared. This was a retrospective study. Results Of the 289 patients, 83(28.7%) developed HT. The incidence of atrial fibrillation, high homocysteine and admission NIHSS score at the time of admission was significantly higher in the HMCAS patients than in non‐HMCAS patients (p < .05). The ASPECTS was significantly lower in HMCAS patients (t = −5.835, p < .001). The incidence of PH‐2 and 3‐month mRS score was also statistically significant higher in HMCAS patients (χ2 = 3.971, p = .046; χ2 = 5.653, p < .001, respectively). A sub‐analysis showed HMCAS patients with HT were significantly older than non‐HMCAS patients with HT (t = 2.473, p = .015). The incidence of atrial fibrillation and the 3‐month mortality rate were higher in HMCAS patients with HT than in non‐HMCAS patients with HT (χ2 = 3.944, p = .047; χ2 = 6.043, p = .014, respectively). Multiple logistic regression analysis showed HT was independently associated with HMCAS (adjusted OR/95% CI/p = 2.762/1.571–4.854/p < .001) and admission NIHSS score (adjusted OR/95% CI/p = 1.081/1.026–1.139/0.003). And HMCAS with HT was independently associated with length of HMCAS (adjusted OR/95% CI/p = 1.216/1.076–1.374/0.002). Conclusions HMCAS in patients with a large cerebral infarction without thrombolytic therapy is an independent biomarker of HT. Length of HMCAS is also a marker of HT with lower ASPECTS in HMCAS patients.

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Quantification of Thrombus Hounsfield Units on Noncontrast CT Predicts Stroke Subtype and Early Recanalization after Intravenous Recombinant Tissue Plasminogen Activator

Abstract: BACKGROUND AND PURPOSE:Little is known about the factors that determine recanalization after intravenous thrombolysis. We assessed the value of thrombus Hounsfield unit quantification as a predictive marker of stroke subtype and MCA recanalization after intravenous rtPA treatment.

Cited by 124 publications

References 36 publications

Proximal flow to middle cerebral artery is associated with higher thrombus density in terminal internal carotid artery occlusion

Proximal flow to middle cerebral artery is associated with higher thrombus density in terminal internal carotid artery occlusion

Disappearance of the Hyperdense Mca Sign after Stroke Thrombolysis: Implications for Prognosis and Early Patient Selection for Clot Retrieval

Hyperdense middle cerebral artery sign in large cerebral infarction

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