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Prediction of thrombus resolution after intravenous thrombolysis assessed by CT-based thrombus imaging

Journal: Thrombosis and Haemostasis
ISSN: 0340-6245
Topic:

Theme Issue
MicroRNAs in vascular biology:
Metabolism and atherosclerosis

DOI: https://doi.org/10.1160/TH11-08-0585
Issue: 2012: 107/4 (Apr) pp. 601-801
Pages: 786-794

Prediction of thrombus resolution after intravenous thrombolysis assessed by CT-based thrombus imaging

Online Supplementary Material

H. S. Nam (1), E. Y. Kim (2), S. H. Kim (3), Y. D. Kim (1), J. Kim (1), H. S. Lee (4), C. M. Nam (4), J. H. Heo (1)

(1) Department of Neurology, Yonsei University College of Medicine, Seoul, Korea; (2) Department of Radiology, Yonsei University College of Medicine, Seoul, Korea; (3) Department of Neurology, Yonsei Wonju University College of Medicine, Wonju, Korea; (4) Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea

Keywords

thrombolytic therapy, computed tomography, cerebrovascular disease, thrombus

Summary

The degree of thrombus resolution directly indicates the effectiveness of a thrombolytic drug. We investigated the degree of thrombus resolution and factors associated with thrombus resolution after intravenous (IV) recombinant tissue plasminogen activator (rt-PA) using thin-section noncontrast computed tomography (NCT). Thin-section NCTs were performed before and immediately after IV rt-PA infusion in acute stroke patients. The thrombus volume and Hounsfield unit were measured using three-dimensional imaging software. Immediate recanalisation was assessed immediately after IV rt-PA infusion using CT angiography. During a three-year study period, 130 patients were prospectively enrolled. On baseline thin-section NCT, no thrombi were found in 30 patients (23%). Among the 100 patients with confirmed thrombus, the median volume decreased by 20% on the follow-up NCT. The thrombus was completely resolved in 8%. Of note, an increase in thrombus volume was observed in 20 patients. Independent predictors of thrombus resolution were total rt-PA dose, thrombus location in the M2 segment of the middle cerebral artery, and time from baseline to follow-up NCT. Thrombus resolution increased by 9% per each 10-mg increase in rt-PA (p = 0.045). Immediate complete recanalisation was achieved in 12% of patients. Total dose of rt-PA was independently associated with complete recanalisation [odds ratio [OR] 4.52, 95% confidence interval [CI] 1.345–15.184) and good functional outcome at three months (modified Rankin scale score <3, OR 2.34, 95% CI 1.104–4.962). In conclusion, rt-PA dose was associated with the degree of thrombus resolution, immediate complete recanalisation, and good outcome at three months. CT-based thrombus imaging may be helpful in determining thrombolysis effectiveness.

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