The presence of a right-to-left shunt is associated with dramatic improvement after thrombolytic therapy in acute ischemic stroke patients

和美, 木村; 保之, 井口; 謙作, 芝崎; 淳哉, 青木; 典子, 松本

doi:10.3995/jstroke.31.380

Cited by 4 publications

(6 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…a hyperdense clot from a cardiac/ venous source vs an iso-or hypodense clot from an arterial source [large arterial disease]) have not always shown robust correlations. [1][2][3]5,7,9,10 In our opinion, a reason for this lack of correlation is that imaging characteristics of clots are a reflection of not just "original clot" characteristics but also new clot formation locally around this original clot (Figure 1). The original clot itself may have varying signal characteristics on imaging depending on the original source of the clot, but because new clot formation can potentially constitute a significant portion of overall total clot burden, the predominant signal from the "total clot" may be heavily influenced by "new" clot constitution than that of the original clot.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8] Previous studies have tried to correlate these imaging characteristics with the primary source of clot formation (cardiac vs large artery or in-situ), albeit with varying results. 2,3,5,9 There is evidence to show that clots that are red blood cell (RBC) rich are hyperdense on NCCT. 2,4 They also tend to bloom more on GRE because of increased deoxy-hemoglobin content.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Thrombus Characteristics Are Related to Collaterals and Angioarchitecture in Acute Stroke

Qazi

Sohn

Mishra

et al. 2015

Can. J. Neurol. Sci.

View full text Add to dashboard Cite

Background: We have theorized that clots with stasis are longer. We therefore explored the relationship between thrombus imaging characteristics on noncontrast computed tomography (NCCT) and magnetic resonance imaging (MRI) with clot length and pial collaterals on baseline computed tomography angiography (CTA). Methods: Prospective study of acute ischemic stroke patients (2005)(2006)(2007)(2008)(2009)) from Keimyung University. Patients with known stroke symptom onset time, baseline CTA, MRI, and with M1-Middle Cerebral Artery (MCA) ± intracranial internal carotid artery (ICA) occlusions were included. Clot length and pial collaterals were measured on baseline CTA. Results: A total of 104 patients (mean age 65.1 ± 12.28 years, 56.7% male, median baseline National Institutes of Health Stroke Scale 13) with intracranial ICA + MCA (n = 50) or isolated M1-MCA (n = 54) occlusions were included. Hyperdense sign on NCCT had a median clot length of 42.3 mm versus 29.5 mm when hyperdense negative (p = 0.02). Clots showing blooming artifact on gradient recall echo MRI had a median length of 39.1 mm versus 24.5 mm without blooming (p = 0.005). Patients with poor baseline collaterals on CTA had longer clots than those with intermediate/good collaterals (median clot length 49.4 mm vs 34.9 mm vs 20.5 mm respectively, p < 0.001). In censored logistic regression modeling, clot length was an independent predictor of hyperdense sign (p = 0.05) and of the presence of blooming artifact (p = 0.006). Conclusions: Clot length and baseline collateral status are independent predictors of clot hyperdensity on NCCT and blooming artifact on gradient recall echo. Longer clots are more likely to be hyperdense and to bloom more, probably because portions of these clots are freshly formed locally due to of stasis of blood around the original clot. This stasis could be because of poor collaterals and inefficient angio-architecture within the cerebral arterial tree.RÉSUMÉ: Les caractéristiques du thrombus sont associées aux collatérales et à l'architecture vasculaire dans l'accident vasculaire cérébral aigu. Contexte: Nous avons émis l'hypothèse que les caillots avec stase sont plus longs. Nous avons donc exploré la relation entre les caractéristiques du caillot, à l'imagerie par tomodensitométrie (CT) sans agent de contraste (CTSAC) et à l'imagerie par résonance magnétique (IRM), et la longueur du caillot et les vaisseaux collatéraux pie-mériens à l'angiographie CT initiale (CTA). Méthode: Cette étude prospective porte sur des patients ayant subi un accident vasculaire cérébral ischémique entre 2005 et 2009 qui ont consulté à l'Université Keinyung. Les patients dont le moment du début des symptômes d'AVC était connu, dont le CTA initial et l'IRM étaient au dossier et qui présentaient une occlusion de l'artère cérébrale moyenne M1 (ACM) ± de la carotide interne intracrânienne (CIIC), ont été inclus dans l'étude. La longueur du caillot et les collatérales pie-mériennes ont été mesurées sur le CTA initial. Résultats: Cent quatre patients...

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Thrombus Characteristics Are Related to Collaterals and Angioarchitecture in Acute Stroke

Qazi

Sohn

Mishra

et al. 2015

Can. J. Neurol. Sci.

View full text Add to dashboard Cite

show abstract

“…1 The authors compared the rates of dramatic improvement (defined as a Ն10-point reduction in the total National Institutes of Health Stroke Scale (NIHSS) score or a total NIHSS score of 0 or 1 at 7 days after tPA infusion) between patients with and without RLS and found that patients with RLS more frequently had dramatic improvement (64.7% versus 32.3%; Pϭ0.030). Importantly, in a multivariate model presence of RLS (odds ratio, 5.9; 95% CI, 1.3 to 27.3; Pϭ0.022) was found to be the only independent factor associated with dramatic improvement.…”

Section: To the Editormentioning

confidence: 99%

“…Kimura et al could not find the thrombi in the leg veins in patients with RLS to account for the source of cerebral embolization. 1 Establishing such associations is often difficult due to various methodological and temporal issues. Doppler ultrasonography of deep veins in the legs may not demonstrate the thrombus because it might have already migrated proximally.…”

Section: To the Editormentioning

confidence: 99%

Should Right-to-Left Shunts Be Detected Before Thrombolysis in Acute Ischemic Stroke Patients?

Sharma

Ahmad

Teoh

et al. 2009

Stroke

View full text Add to dashboard Cite

“…Preliminary studies in human patients with stroke revealed similar results. Here, strokes caused by paradoxical embolism, which is considered to result from an erythrocyte-rich thrombus in the deep venous system, were found to be more sensitive to recombinant tissue plasminogen activator treatment compared with strokes of other etiologies, 7 but detailed analyses are lacking due to limited clot accessibility. The increasing use of mechanical embolectomy devices now allows for retrieving fresh clots from patients with acute stroke and successive morphological characterization.…”

mentioning

confidence: 99%

Visualization of Clot Composition in Ischemic Stroke

Minnerup

Kleinschnitz

2011

Stroke

View full text Add to dashboard Cite

The presence of a right-to-left shunt is associated with dramatic improvement after thrombolytic therapy in acute ischemic stroke patients

Cited by 4 publications

References 9 publications

Thrombus Characteristics Are Related to Collaterals and Angioarchitecture in Acute Stroke

Thrombus Characteristics Are Related to Collaterals and Angioarchitecture in Acute Stroke

Should Right-to-Left Shunts Be Detected Before Thrombolysis in Acute Ischemic Stroke Patients?

Visualization of Clot Composition in Ischemic Stroke

Contact Info

Product

Resources

About