Thrombus Permeability Is Associated With Improved Functional Outcome and Recanalization in Patients With Ischemic Stroke.

Santos, Emilie M M; Marquering, Henk A; den Blanken, Mark D; Berkhemer, Olvert A; Boers, Anna M M; Yoo, Albert J; Beenen, Ludo F; Treurniet, Kilian M; Wismans, Carrie; van Noort, Kim; Lingsma, Hester F; Dippel, Diederik W J; van der Lugt, Aad; van Zwam, Wim H; Roos, Yvo B W E M; van Oostenbrugge, Robert J; Niessen, Wiro J; Majoie, Charles B; Mattle, Heinrich (2016). Thrombus Permeability Is Associated With Improved Functional Outcome and Recanalization in Patients With Ischemic Stroke. Stroke, 47(3), pp. 732-741. Lippincott Williams & Wilkins 10.1161/STROKEAHA.115.011187

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BACKGROUND AND PURPOSE Preclinical studies showed that thrombi can be permeable and may, therefore, allow for residual blood flow in occluded arteries of patients having acute ischemic stroke. This perviousness may increase tissue oxygenation, improve thrombus dissolution, and augment intra-arterial treatment success. We hypothesize that the combination of computed tomographic angiography and noncontrast computed tomography imaging allows measurement of contrast agent penetrating a permeable thrombus, and it is associated with improved outcome. METHODS Thrombus and contralateral artery attenuations in noncontrast computed tomography and computed tomographic angiography images were measured in 184 Multicenter Randomized Clinical trial of Endovascular treatment of acute ischemic stroke in the Netherlands (MR CLEAN) patients with thin-slice images. Two quantitative estimators of the thrombus permeability were introduced: computed tomographic angiography attenuation increase (Δ) and thrombus void fraction (ε). Patients were dichotomized as having a pervious or impervious thrombus and associated with outcome, recanalization, and final infarct volume. RESULTS Patients with Δ≥10.9 HU (n=81 [44%]) and ε≥6.5% (n=77 [42%]) were classified as having a pervious thrombus. These patients were 3.2 (95% confidence interval, 1.7-6.4) times more likely to have a favorable outcome, and 2.5 (95% confidence interval, 1.3-4.8) times more likely to recanalyze, for Δ based classification, and similarly for ε. These odds ratios were independent from intravenous or intra-arterial treatment. Final infarct volume was negatively correlated with both perviousness estimates (correlation coefficient, -0.39 for Δ and -0.40 for ε). CONCLUSIONS This study shows that simultaneous measurement of thrombus attenuation in noncontrast computed tomography and computed tomographic angiography allows for quantification of thrombus perviousness. Thrombus perviousness is strongly associated with improved functional outcome, smaller final infarct volume, and higher recanalization rate.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DCR Unit Sahli Building > Forschungsgruppe Neurologie
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Mattle, Heinrich


600 Technology > 610 Medicine & health




Lippincott Williams & Wilkins




Stefanie Hetzenecker

Date Deposited:

29 Mar 2017 10:37

Last Modified:

29 Mar 2017 20:13

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

arteries; permeability; reperfusion; stroke; thrombosis




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