Permeable Thrombi Are Associated With Higher Intravenous Recombinant Tissue-Type Plasminogen Activator Treatment Success in Patients With Acute Ischemic Stroke

AUTHOR GROUP

doi:https://doi.org/10.1161/STROKEAHA.116.013306

Permeable Thrombi Are Associated With Higher Intravenous Recombinant Tissue-Type Plasminogen Activator Treatment Success in Patients With Acute Ischemic Stroke

AUTHOR GROUP

Research output: Contribution to journal › Article › Academic › peer-review

60 Citations (Scopus)

Abstract

Preclinical studies showed that thrombus permeability improves recombinant tissue-type plasminogen activator (r-tPA) efficacy. We hypothesize that thrombus permeability estimated from radiological imaging is associated with improved recanalization after treatment with intravenously administered r-tPA (r-tPA) and with better functional outcome. We assessed thrombus attenuation increase (TAI) in patients from the Dutch Acute Stroke Study with an occlusion of an intracranial artery on computed tomographic angiography. Patients were included within 9 hours after the stroke onset. After dichotomization of TAI as pervious or impervious, logistic regressions analyses were performed to estimate associations of intravenous r-tPA therapy with complete recanalization and with favorable functional outcome (modified Rankin Scale score of ≤2). Three hundred eight patients matched the inclusion criteria. The median TAI was 20.1 (interquartile range, 8.5-37.8) Hounsfield unit (HU). We found a significant increase in the odds of complete recanalization with increasing TAI for patients treated with intravenous r-tPA (P=0.030). One hundred thirty-one (42%) thrombi were classified as pervious with TAI of ≥23 HU. In patients with a pervious thrombus, complete recanalization was more frequent after treatment with intravenous r-tPA than after conservative treatment (odds ratio, 6.26; 95% confidence interval, 2.4-16.8; P <0.001). In patients with an impervious thrombus, the effect of intravenous r-tPA was not significant (odds ratio, 1.4; 95% confidence interval, 0.5-4.1; P=0.47). Favorable outcome was more common in patients with a pervious thrombi than without (odds ratio, 2.1; 95% confidence interval, 1.3-3.4; P=0.001). Thrombus perviousness, as measured on computed tomography in the acute stage of ischemic stroke, is strongly associated with recanalization after intravenous r-tPA treatment and with favorable functional outcome

Original language	English
Pages (from-to)	2058-2065
Journal	Stroke; a journal of cerebral circulation
Volume	47
Issue number	8
DOIs	https://doi.org/10.1161/STROKEAHA.116.013306
Publication status	Published - 2016

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https://doi.org/10.1161/STROKEAHA.116.013306

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@article{18bcb103ec1249249572d46de1b65ea6,

title = "Permeable Thrombi Are Associated With Higher Intravenous Recombinant Tissue-Type Plasminogen Activator Treatment Success in Patients With Acute Ischemic Stroke",

abstract = "Preclinical studies showed that thrombus permeability improves recombinant tissue-type plasminogen activator (r-tPA) efficacy. We hypothesize that thrombus permeability estimated from radiological imaging is associated with improved recanalization after treatment with intravenously administered r-tPA (r-tPA) and with better functional outcome. We assessed thrombus attenuation increase (TAI) in patients from the Dutch Acute Stroke Study with an occlusion of an intracranial artery on computed tomographic angiography. Patients were included within 9 hours after the stroke onset. After dichotomization of TAI as pervious or impervious, logistic regressions analyses were performed to estimate associations of intravenous r-tPA therapy with complete recanalization and with favorable functional outcome (modified Rankin Scale score of ≤2). Three hundred eight patients matched the inclusion criteria. The median TAI was 20.1 (interquartile range, 8.5-37.8) Hounsfield unit (HU). We found a significant increase in the odds of complete recanalization with increasing TAI for patients treated with intravenous r-tPA (P=0.030). One hundred thirty-one (42%) thrombi were classified as pervious with TAI of ≥23 HU. In patients with a pervious thrombus, complete recanalization was more frequent after treatment with intravenous r-tPA than after conservative treatment (odds ratio, 6.26; 95% confidence interval, 2.4-16.8; P <0.001). In patients with an impervious thrombus, the effect of intravenous r-tPA was not significant (odds ratio, 1.4; 95% confidence interval, 0.5-4.1; P=0.47). Favorable outcome was more common in patients with a pervious thrombi than without (odds ratio, 2.1; 95% confidence interval, 1.3-3.4; P=0.001). Thrombus perviousness, as measured on computed tomography in the acute stage of ischemic stroke, is strongly associated with recanalization after intravenous r-tPA treatment and with favorable functional outcome",

author = "Santos, {Emilie M. M.} and Dankbaar, {Jan Willem} and Treurniet, {Kilian M.} and Horsch, {Alexander D.} and Roos, {Yvo B.} and Kappelle, {L. Jaap} and Niessen, {Wiro J.} and Majoie, {Charles B.} and Birgitta Velthuis and Marquering, {Henk A.} and {AUTHOR GROUP} and Duijm, {L. E.} and K. Keizer and {van der Lugt}, A. and Dippel, {D. W.} and {Droogh-de Greeve}, {K. E.} and Bienfait, {H. P.} and {van Walderveen}, {M. A.} and Wermer, {M. J.} and {Lycklama {\`a} Nijeholt}, {G. J.} and J. Boiten and D. Duyndam and Kwa, {I. V.} and Meijer, {J. F.} and {van Dijk}, {E. J.} and Kesselring, {F. O.} and J. Hofmeijer and Vos, {J. A.} and Schonewille, {W. J.} and {van Rooij}, {W. J.} and {de Kort}, {P. L.} and Pleiter, {C. C.} and Bakker, {S. L.} and J. Bot and Visser, {M. C.} and {van der Schaaf}, {I. C.} and Mali, {W. P.} and {van Seeters}, T. and Niesten, {J. M.} and Biessels, {G. J.} and Luitse, {M. J.} and {van der Graaf}, Y.",

year = "2016",

doi = "https://doi.org/10.1161/STROKEAHA.116.013306",

language = "English",

volume = "47",

pages = "2058--2065",

journal = "Stroke; a journal of cerebral circulation",

issn = "0039-2499",

publisher = "Lippincott Williams & Wilkins",

number = "8",

}

TY - JOUR

T1 - Permeable Thrombi Are Associated With Higher Intravenous Recombinant Tissue-Type Plasminogen Activator Treatment Success in Patients With Acute Ischemic Stroke

AU - Santos, Emilie M. M.

AU - Dankbaar, Jan Willem

AU - Treurniet, Kilian M.

AU - Horsch, Alexander D.

AU - Roos, Yvo B.

AU - Kappelle, L. Jaap

AU - Niessen, Wiro J.

AU - Majoie, Charles B.

AU - Velthuis, Birgitta

AU - Marquering, Henk A.

AU - AUTHOR GROUP

AU - Duijm, L. E.

AU - Keizer, K.

AU - van der Lugt, A.

AU - Dippel, D. W.

AU - Droogh-de Greeve, K. E.

AU - Bienfait, H. P.

AU - van Walderveen, M. A.

AU - Wermer, M. J.

AU - Lycklama à Nijeholt, G. J.

AU - Boiten, J.

AU - Duyndam, D.

AU - Kwa, I. V.

AU - Meijer, J. F.

AU - van Dijk, E. J.

AU - Kesselring, F. O.

AU - Hofmeijer, J.

AU - Vos, J. A.

AU - Schonewille, W. J.

AU - van Rooij, W. J.

AU - de Kort, P. L.

AU - Pleiter, C. C.

AU - Bakker, S. L.

AU - Bot, J.

AU - Visser, M. C.

AU - van der Schaaf, I. C.

AU - Mali, W. P.

AU - van Seeters, T.

AU - Niesten, J. M.

AU - Biessels, G. J.

AU - Luitse, M. J.

AU - van der Graaf, Y.

PY - 2016

Y1 - 2016

N2 - Preclinical studies showed that thrombus permeability improves recombinant tissue-type plasminogen activator (r-tPA) efficacy. We hypothesize that thrombus permeability estimated from radiological imaging is associated with improved recanalization after treatment with intravenously administered r-tPA (r-tPA) and with better functional outcome. We assessed thrombus attenuation increase (TAI) in patients from the Dutch Acute Stroke Study with an occlusion of an intracranial artery on computed tomographic angiography. Patients were included within 9 hours after the stroke onset. After dichotomization of TAI as pervious or impervious, logistic regressions analyses were performed to estimate associations of intravenous r-tPA therapy with complete recanalization and with favorable functional outcome (modified Rankin Scale score of ≤2). Three hundred eight patients matched the inclusion criteria. The median TAI was 20.1 (interquartile range, 8.5-37.8) Hounsfield unit (HU). We found a significant increase in the odds of complete recanalization with increasing TAI for patients treated with intravenous r-tPA (P=0.030). One hundred thirty-one (42%) thrombi were classified as pervious with TAI of ≥23 HU. In patients with a pervious thrombus, complete recanalization was more frequent after treatment with intravenous r-tPA than after conservative treatment (odds ratio, 6.26; 95% confidence interval, 2.4-16.8; P <0.001). In patients with an impervious thrombus, the effect of intravenous r-tPA was not significant (odds ratio, 1.4; 95% confidence interval, 0.5-4.1; P=0.47). Favorable outcome was more common in patients with a pervious thrombi than without (odds ratio, 2.1; 95% confidence interval, 1.3-3.4; P=0.001). Thrombus perviousness, as measured on computed tomography in the acute stage of ischemic stroke, is strongly associated with recanalization after intravenous r-tPA treatment and with favorable functional outcome

AB - Preclinical studies showed that thrombus permeability improves recombinant tissue-type plasminogen activator (r-tPA) efficacy. We hypothesize that thrombus permeability estimated from radiological imaging is associated with improved recanalization after treatment with intravenously administered r-tPA (r-tPA) and with better functional outcome. We assessed thrombus attenuation increase (TAI) in patients from the Dutch Acute Stroke Study with an occlusion of an intracranial artery on computed tomographic angiography. Patients were included within 9 hours after the stroke onset. After dichotomization of TAI as pervious or impervious, logistic regressions analyses were performed to estimate associations of intravenous r-tPA therapy with complete recanalization and with favorable functional outcome (modified Rankin Scale score of ≤2). Three hundred eight patients matched the inclusion criteria. The median TAI was 20.1 (interquartile range, 8.5-37.8) Hounsfield unit (HU). We found a significant increase in the odds of complete recanalization with increasing TAI for patients treated with intravenous r-tPA (P=0.030). One hundred thirty-one (42%) thrombi were classified as pervious with TAI of ≥23 HU. In patients with a pervious thrombus, complete recanalization was more frequent after treatment with intravenous r-tPA than after conservative treatment (odds ratio, 6.26; 95% confidence interval, 2.4-16.8; P <0.001). In patients with an impervious thrombus, the effect of intravenous r-tPA was not significant (odds ratio, 1.4; 95% confidence interval, 0.5-4.1; P=0.47). Favorable outcome was more common in patients with a pervious thrombi than without (odds ratio, 2.1; 95% confidence interval, 1.3-3.4; P=0.001). Thrombus perviousness, as measured on computed tomography in the acute stage of ischemic stroke, is strongly associated with recanalization after intravenous r-tPA treatment and with favorable functional outcome

U2 - https://doi.org/10.1161/STROKEAHA.116.013306

DO - https://doi.org/10.1161/STROKEAHA.116.013306

M3 - Article

C2 - 27338928

SN - 0039-2499

VL - 47

SP - 2058

EP - 2065

JO - Stroke; a journal of cerebral circulation

JF - Stroke; a journal of cerebral circulation

IS - 8

ER -