Associations of thrombus perviousness derived from entire thrombus segmentation with functional outcome in patients with acute ischemic stroke

Emilie M.M. Santos, Nerea Arrarte Terreros, Manon Kappelhof, Jordi Borst, Anna M.M. Boers, Hester F. Lingsma, Olvert A. Berkhemer, Diederik W.J. Dippel, Charles B. Majoie, Henk A. Marquering*, Wiro J. Niessen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Thrombus perviousness is strongly associated with functional outcome and intravenous alteplase treatment success in patients with acute ischemic stroke. Accuracy of thrombus attenuation increase (TAI) assessment may be compromised by a heterogeneous thrombus composition and interobserver variations of currently used manual measurements. We hypothesized that TAI is more strongly associated with clinical outcomes when evaluated on the entire thrombus. In 195 patients, five TAI measures were performed: one manual by placing three regions of interest (TAImanual) and four automated ones assessing densities from the entire thrombus. The automated TAI measures were calculated by comparing quartiles; Q1, Q2, and Q3 of the non-contrast and contrast enhanced thrombus density distribution and using the lag of the maximum of the cross correlations (MCC). Associations with functional outcome (mRS at 90 days) were assessed with univariate and multivariable analyses. All entire TAI measures were significantly associated with functional outcome with odd ratios (OR) of 1.63(95 %CI:1.19–2.25, p = 0.003) for Q1, 1.56(95 %CI:1.16–2.10, p = 0.003) for Q2, 1.24(95 %CI:1.00–1.54, p = 0.045) for Q3, and 1.70(95 %CI:1.24–2.34, p = 0.001) for MCC per 10 HU increase in univariate models. TAImanual was not significantly associated with functional outcome (p = 0.055). In the multivariable logistic regression models including age, NIHSS, and recanalization, only TAI measures derived from the entire thrombus were independently associated with favorable outcome; OR of 1.64(95 %CI:1.01–2.66, p = 0.048) for Q2 and 1.82(1.13–2.95, p = 0.014) for MCC per 10 HU increase of thrombus attenuation. The novel perviousness measures of the entire thrombus are more strongly associated with functional outcome than the traditional manual perviousness assessments.

Original languageEnglish
Article number110700
JournalJournal of Biomechanics
Volume128
DOIs
Publication statusPublished - 9 Nov 2021

Bibliographical note

Funding Information:
This study has been funded by the Technology Foundation STW under Grant 11632, http://www.carisma-airspace.nl , ITEA2 project MEDUSA under grant number 10004, https://itea3.org/project/medusa.html , and the European Union Horizon 2020 research and innovation program under grant number 777072, https://www.insist-h2020.eu/ .

Funding Information:
The MR CLEAN trial was funded by the Dutch Heart Foundation and through unrestricted grants from AngioCare BV, Covidien/EV3®, MEDAC Gmbh/LAMEPRO and Penumbra Inc.

Publisher Copyright:
© 2021

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