Association of thrombus density and endovascular treatment outcomes in patients with acute ischemic stroke due to M1 occlusions

Bruggeman, Agnetha A E; Aberson, Nyk; Kappelhof, Manon; Dutra, Bruna Garbugio; Hoving, Jan W; Brouwer, Josje; Tolhuisen, Manon L.; Terreros, Nerea Arrarte; Konduri, Praneeta; Boodt, Nikki; Roos, Yvo B.W.E.M.; Zwam, Wim H. van; Bokkers, Reinoud P H; Martens, Jasper M.; Marquering, Henk A.; Emmer, Bart J.; Majoie, Charles B. L. M.

doi:10.1007/s00234-022-02971-4

Cited by 2 publications

(1 citation statement)

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“…The observation that high attenuating thrombi are more likely to be recanalized is not generally made. A growing number of studies (for a summary of the key references, see Supplemental Table S1 ) draw into question the relationship between high thrombus density and recanalization success [ 16 , 17 , 18 , 19 , 20 , 21 , 22 ] for which several factors may be responsible.…”

Section: Discussionmentioning

confidence: 99%

Thrombus Density in Acute Basilar Artery Occlusion Depends on Slice Thickness and the Method of Manual Thrombus Delineation

Shen

Meyne

Jansen

et al. 2022

Life

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Introduction: High thrombus attenuation on CT has been suggested as a predictor of successful recanalization. It is as well speculated that thrombi of different density may be susceptible to different methods of mechanical thrombectomy. In this study we sought to determine the effect of different methods of manual thrombus delineation and reconstructed slice thickness on thrombus density. Material and Methods: Fifty-six patients with acute occlusion of the basilar artery treated with endovascular therapy were retrospectively included. Clinical, demographic, radiological and outcome parameters were collected. Two raters measured absolute and relative thrombus density employing three different methods (one region of interest, three regions of interest, whole thrombus delineation) and using three different reconstructed slice thicknesses (0.625, 2.5 and 5 mm) of the original admission CT. Results: Thirty-nine patients were successfully recanalized (thrombolysis in cerebral infarction score ≥ 2b). Good clinical outcome (modified Rankin scale ≤ 2) occurred significantly more often in the recanalized group (36 vs. 6%, p = 0.023, Fisher’s exact test), in the non-recanalized group symptomatic intracranial hemorrhage occurred more often (9 vs. 29%, p = 0.001, Fisher’s exact test). Absolute and relative thrombus density were largely different between methods and slice thicknesses. Multiple regression showed a decrease of thrombus density with increasing slice thickness (β = −3.98, p < 0.001) and logistic regression showed a statistically significant but very small relation between density and recanalization (β = 0.006, odds ratio (95% confidence interval) = 1.006 (1.003–1.01), p < 0.001). Conclusions: The methods for manual thrombus delineation and reconstructed slice thickness had a significant influence on absolute and relative thrombus density. Density alone may be of limited value as a predictive marker for recanalization success in acute occlusion of the basilar artery. Standards for density measurements must be defined when comparing different studies and when evaluating different methods of mechanical thrombectomy.

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