Computed Tomography-Based Thrombus Imaging for the Prediction of Recanalization after Reperfusion Therapy in Stroke

Abstract

The prediction of successful recanalization following thrombolytic or endovascular treatment may be helpful to determine the strategy of recanalization treatment in acute stroke. Thrombus can be detected using noncontrast computed tomography (CT) as a hyperdense artery sign or blooming artifact on a T2*-weighted gradient-recalled image. The detection of thrombus using CT depends on slice thickness. Thrombus burden can be determined in terms of the length, volume, and clot burden score. The thrombus size can be quantitatively measured on thin-section CT or CT angiography/magnetic resonance angiography. The determination of thrombus size may be predictive of successful recanalization/non-recanalization after intravenous thrombolysis and endovascular treatment. However, cut-offs of thrombus size for predicting recanalization/non-recanalization are different among studies, due to different methods of measurements. Thus, a standardized method to measure the thrombus is necessary for thrombus imaging to be useful and reliable in clinical practice. Software-based measurements may provide a reliable and accurate assessment. The measurement should be easy and rapid to be more widely used in practice, which could be achieved by improvement of the user interface. In addition to prediction of recanalization, sequential measurements of thrombus volume before and after the treatment may also be useful to determine the efficacy of new thrombolytic drugs. This manuscript reviews the diagnosis of thrombus, prediction of recanalization using thrombus imaging, and practical considerations for the measurement of thrombus burden and density on CT.

Predictive value of thrombus volume for recanalization in stent retriever thrombectomy

“…Previous studies have shown inconsistent findings in terms of the association between the thrombus burden and recanalization after mechanical thrombectomy by means of an SR 6 , 9 – 15 . The inconsistency between the studies might be partly ascribed to differences in the method used to measure thrombus burden and the number of patients 16 . Thrombus length and clot burden score could be surrogates for clot burden.…”

Rates and Quality of Preinterventional Reperfusion in Patients With Direct Access to Endovascular Treatment

“…Distal thrombus ends were evaluated either directly on susceptibility-weighted imaging, postcontrast T1, or thin-slice noncontrast CT or indirectly as indicated by the flowstagnation of collateralized vessels on late phase contrast-enhanced MRA or late phase CTA. 16 Thrombus length was calculated using a freehand curve function as measurements between the proximal and distal thrombus ends.…”

“…These numbers increased to 13 (95% CI, [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] and 35 (95% CI, 18-464) when analysis was confined to M1 (proximal and distal) and ICA occlusions (SWIFT DIRECT trial cohort [Solitaire With the Intention for Thrombectomy Plus Intravenous t-PA Versus DIRECT Solitaire Stent-Retriever Thrombectomy in Acute Anterior Circulation Stroke], URL: http://www.clinicaltrials. gov.…”

Steering of magnetotactic bacterial microrobots by focusing magnetic field for targeted pathogen killing

“…Although our analyses and experiments were carried out in two dimensional space, the case in three dimension is similar. In general, acquiring a vascular shape in the human body is feasible by means of some techniques, including magnetic resonance imaging [28,29], computed tomography [30], and angiography [31]. In a three dimensional environment, the guidance of magnetotactic bacterial microrobots could also be achieved if three dimensional channels are content with the similar monotonic functions (i.e.…”