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Thrombus Volume as a Predictor of Nonrecanalization After Intravenous Thrombolysis in Acute Stroke.

 Joonsang Yoo  ;  Jang-Hyun Baek  ;  Hyungjong Park  ;  Dongbeom Song  ;  Kyoungsub Kim  ;  In Gun Hwang  ;  Young Dae Kim  ;  Seo Hyun Kim  ;  Hye Sun Lee  ;  Seong Hwan Ahn  ;  Han-Jin Cho  ;  Gyu Sik Kim  ;  Jinkwon Kim  ;  Kyung-Yul Lee  ;  Tae-Jin Song  ;  Hye-Yeon Choi  ;  Hyo Suk Nam  ;  Ji Hoe Heo 
 Stroke, Vol.49(9) : 2108-2115, 2018 
Journal Title
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cerebral infarction ; computed tomography angiography ; stroke ; thrombus
Background and Purpose- We investigated whether measuring the volume and density of a thrombus could predict nonrecanalization after intravenous thrombolysis. Methods- This study included a retrospective cohort to develop a computed tomography marker of thrombus for predicting nonrecanalization after intravenous thrombolysis and a prospective multicenter cohort for validation of this marker. The volume and density of thrombus were measured semiautomatically using 3-dimensional software on a baseline thin-section noncontrast computed tomography (1 or 1.25 mm). Recanalization was assessed on computed tomography angiography or magnetic resonance angiography immediately after intravenous thrombolysis or conventional angiography in patients who underwent further intra-arterial treatment. Nonrecanalization was defined as a modified Thrombolysis in Cerebral Infarction grade 0, 1, 2a. Results- In the retrospective cohort, 162 of 214 patients (76.7%) failed to achieve recanalization. The thrombus volume was significantly larger in patients with nonrecanalization than in those with successful recanalization (149.5±127.6 versus 65.3±58.3 mm3; P<0.001). In the multivariate analysis, thrombus volume was independently associated with nonrecanalization ( P<0.001). The cutoff for predicting nonrecanalization was calculated as 200 mm3. In the prospective multicenter validation study, none of the patients with a thrombus volume ≥200 mm3 among 78 enrolled patients achieved successful recanalization. The positive and negative predictive values were 95.5 and 29.4 in the retrospective cohort 100 and 23.3 in the prospective validation cohort, respectively. The thrombus density was not associated with nonrecanalization. Conclusions- Thrombus volume was predictive of nonrecanalization after intravenous thrombolysis. Measurement of thrombus volume may help in determining the recanalization strategy and perhaps identify patients suitable for direct endovascular thrombectomy.
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1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
김경섭(Kim, Kyoung Sub)
김영대(Kim, Young Dae) ORCID logo https://orcid.org/0000-0001-5750-2616
남효석(Nam, Hyo Suk) ORCID logo https://orcid.org/0000-0002-4415-3995
박형종(Park, Hyungjong)
송동범(Song, Dong Beom)
유준상(Yoo, Joon Sang)
이경열(Lee, Kyung Yul) ORCID logo https://orcid.org/0000-0001-5585-7739
이혜선(Lee, Hye Sun) ORCID logo https://orcid.org/0000-0001-6328-6948
허지회(Heo, Ji Hoe) ORCID logo https://orcid.org/0000-0001-9898-3321
황인건(Hwang, In Gun) ORCID logo https://orcid.org/0000-0002-5193-4060
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