Vignan Yogendrakumar, MD, MSc
Kappelhof M, Tolhuisen ML, Treurniet KM, Dutra BG, Alves H, Zhang G, Brown S, Muir KW, Dávalos A, Roos YBWEM, et al. Endovascular Treatment Effect Diminishes With Increasing Thrombus Perviousness: Pooled Data From 7 Trials on Acute Ischemic Stroke. Stroke. 2021.
In the context of large vessel occlusion stroke, a growing number of advanced imaging studies are showing us that no two occlusions are alike. The imaging features of a thrombus can provide critical information that can inform us about the effectiveness of a given therapy. For example, the INTERRSeCT study published in 2018 showed that distal thrombus location and increased thrombus permeability were associated with increased rates of spontaneous recanalization with IV thrombolysis.
In this study, Kappelhof and colleagues utilize data from the HERMES dataset to assess thrombus permeability and determine its effect on clinical outcomes in patients who received EVT compared to those who received thrombolysis alone. The authors refer to permeability as “thrombus perviousness” and measured this by co-registering non-contrast CT (NCCT) and single-phase CTA images together and measuring the attenuation increase between NCCT and CTA images (Figure 2). The primary clinical outcome of the study was an ordinal analysis of the mRS.