Efficacy of thrombus density on noninvasive computed tomography neuroimaging for predicting thrombus pathology and patient outcome after mechanical thrombectomy in acute ischemic stroke

Dittapong Songsaeng; Tharathorn Kaeowirun; Ittichai Sakarunchai; Pornsuk Cheunsuchon; Jaruwan Weankhanan; Anek Suwanbundit; Timo Krings

doi:10.4103/ajns.AJNS_238_18

Asian Journal of Neurosurgery, Table of Contents

CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(03): 795-800
DOI: 10.4103/ajns.AJNS_238_18

Original Article

Efficacy of thrombus density on noninvasive computed tomography neuroimaging for predicting thrombus pathology and patient outcome after mechanical thrombectomy in acute ischemic stroke

Authors

Dittapong Songsaeng

¹Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok
Tharathorn Kaeowirun

¹Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok
Ittichai Sakarunchai

¹Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok

²Department of Surgery, Division of Neurosurgery, Faculty of Medicine, Prince of Songkla University, Hat Yai
Pornsuk Cheunsuchon

³Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok
Jaruwan Weankhanan

¹Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok
Anek Suwanbundit

¹Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok
Timo Krings

⁴Department of Medical Imaging, Division of Neuroradiology, Faculty of Medicine, University of Toronto

Abstract

Background and Purpose: The aim of this study was to investigate the efficacy of thrombus density on noninvasive computed tomography (CT) neuroimaging for predicting thrombus pathology and patient outcome after mechanical thrombectomy in acute ischemic stroke. Materials and Methods: This retrospective chart and imaging review included patients that were treated by mechanical thrombectomy at Siriraj Hospital according to the American Heart Association/American Stroke Association guidelines for the early management of patients with acute ischemic stroke from March 2010 to February 2015 study period. Preintervention noncontrast CT (NCCT), CT angiography (CTA), and/or contrast-enhanced CT (CECT) images were interpreted using CT densitometry. Pathology results were classified as white, red, or mixed thrombi. The result of treatment was evaluated by the modified Rankin Scale at 90 days after treatment. Results: From 97 included patients – 97 NCCT images, 48 CTA images, 48 CECT images, and 54 pathologic results of cerebral thrombi were included in the final analysis. Mean clot Hounsfield unit values on NCCT, CTA, and CECT were significantly different between red and white thrombus (P = 0.001 on NCCT, P = 0.03 on CTA, and P = 0.001 on CECT), and between red and mixed thrombus (P = 0.043 on NCCT and P = 0.002 on CTA). However, no significant difference was observed between white thrombus and mixed thrombus (P = 0.09 on NCCT, P = 1.00 on CTA, and P = 0.054 on CECT). There was no significant correlation between type of cerebral thrombus or clot density and the result of treatment. Conclusion: Thrombus density on CT was found to be a significant predictor of thrombus pathology; however, no significant association was observed between thrombus type or clot density and patient outcome after mechanical thrombectomy.

Key-words:

Acute ischemic stroke - Hounsfield units - mechanical thrombectomy - noninvasive computed tomography neuroimaging - Thailand - thrombus pathology

Full Text

References

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