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Thromb Haemost 2012; 107(04): 786-794
DOI: 10.1160/TH11-08-0585
New Technologies, Diagnostic Tools and Drugs
Schattauer GmbH

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

Hyo Suk Nam
1   Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
,
Eung Yeop Kim
2   Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
,
Seo Hyun Kim
3   Department of Neurology, Yonsei Wonju University College of Medicine, Wonju, Korea
,
Young Dae Kim
1   Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
,
Jinkwon Kim
1   Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
,
Hye Sun Lee
4   Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea
,
Chung Mo Nam
4   Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea
,
Ji Hoe Heo
1   Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
› Institutsangaben Financial support: This study was supported by a grant of the Korea Health 21 R&D Project, Ministry of Health & Welfare, Republic of Korea (A102065, A085136).
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Publikationsverlauf

Received: 27. August 2011

Accepted after major revision: 05. Januar 2012

Publikationsdatum:
29. November 2017 (online)

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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.

Keywords

Computed tomography - thrombus - thrombolytic therapy - cerebrovascular disease

 

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