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

Research output: Contribution to journalArticlepeer-review

39 Scopus citations


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.

Original languageEnglish
Pages (from-to)2108-2115
Number of pages8
Issue number9
StatePublished - 2018

Bibliographical note

Publisher Copyright:
© 2018 American Heart Association, Inc.


  • Cerebral infarction
  • Computed tomography angiography
  • Stroke
  • Thrombus


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