Incidence, Risk Factors, and Clinical Implications of Subarachnoid Hyperdensities on Flat-Panel Detector CT following Mechanical Thrombectomy in Patients with Anterior Circulation Acute Ischemic Stroke

Serrallach, Bettina L.; Branca, Mattia; Mujanovic, Adnan; Boronylo, Anna; Hanke, Julie M.; Hakim, Arsany; Pilgram-Pastor, Sara; Piechowiak, Eike I.; Gralla, Jan; Meinel, Thomas; Kaesmacher, Johannes; Dobrocky, Tomas

doi:10.3174/ajnr.a8277

AJNR Am J Neuroradiol

2024

DOI: 10.3174/ajnr.a8277

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Incidence, Risk Factors, and Clinical Implications of Subarachnoid Hyperdensities on Flat-Panel Detector CT following Mechanical Thrombectomy in Patients with Anterior Circulation Acute Ischemic Stroke

Bettina L. Serrallach,

Mattia Branca,

Adnan Mujanovic

et al.

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2024

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DOT sign indicates persistent hypoperfusion and poor outcome in patients with incomplete reperfusion following thrombectomy

Mujanovic,

Windecker,

Serrallach

et al. 2024

J NeuroIntervent Surg

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BackgroundDistal occlusions associated with incomplete reperfusion (expanded Thrombolysis in Cerebral Infarction, <eTICI 3) may not reperfuse spontaneously and thus prompt ischemia (ie, persistent hypoperfusion). We aimed to assess whether the recently reported Distal Occlusion Tracker (DOT) sign on immediate non-contrast post-interventional flat-panel detector computed tomography (FPDCT) is associated with persistent hypoperfusion.MethodsRetrospective registry analysis of patients undergoing endovascular therapy between July 2020 and December 2022, with available immediate post-interventional FPDCT and 24 hours follow-up perfusion imaging. Persistent hypoperfusion was defined as a perfusion deficit at 24 hours directly corresponding to the area of incomplete reperfusion on final angiography run. The DOT sign was defined as a punctiform or tubular hyperdense signal increase on FPDCT indicative of a residual occlusion. Association between the DOT sign (present/absent) with the occurrence of persistent hypoperfusion and poor outcome (modified Rankin scale (mRS) score 3–6) was evaluated using logistic regression analysis.ResultsOf 292 patients included (median age 73 years; 47% female), 209 had incomplete reperfusion. Among patients with incomplete reperfusion, 61% had a present DOT sign and 46% had persistent hypoperfusion. In the overall cohort, but also within each eTICI stratum, a present DOT sign was associated with persistent hypoperfusion on 24±12 hours follow-up perfusion imaging (adjusted odds ratio (aOR) 4.8, 95% confidence interval (CI) 2.0 to 12.3 for patients with eTICI 2 a-2c). A present DOT sign was also associated with poor outcome (aOR 2.6, 95% CI 1.1 to 6.2).ConclusionPatients with <eTICI 3 and a present DOT sign have a higher likelihood of persistent hypoperfusion and might constitute a subgroup that could particularly benefit from additional reperfusion attempts.

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DOT sign indicates persistent hypoperfusion and poor outcome in patients with incomplete reperfusion following thrombectomy

Mujanovic,

Windecker,

Serrallach

et al. 2024

J NeuroIntervent Surg

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Incidence, Risk Factors, and Clinical Implications of Subarachnoid Hyperdensities on Flat-Panel Detector CT following Mechanical Thrombectomy in Patients with Anterior Circulation Acute Ischemic Stroke

Cited by 1 publication

References 43 publications

DOT sign indicates persistent hypoperfusion and poor outcome in patients with incomplete reperfusion following thrombectomy

DOT sign indicates persistent hypoperfusion and poor outcome in patients with incomplete reperfusion following thrombectomy

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