Article Figures & Data
Figures
- Fig 1.
A, M1 MCA occluded segment (white arrows) with patent proximal M1 MCA on the right and the contralateral M1 MCA (white arrowheads). B, Clot length (broken white line; segment a) and distance from M1 MCA origin to proximal clot interface (broken black line; segment b). Measurement of the contralateral M1 MCA segment is shown for reference (segment c).
- Fig 2.
Residual flow on baseline CT angiography along with early reperfusion with IV tPA assessed on the first angiogram of the ipsilesional arterial tree. The top panel shows a patient with a left M1 MCA clot and no residual flow (A, grade 0 residual flow, yellow arrows, density similar to that of surrounding brain parenchyma). The first angiogram shows no recanalization (B and C). The middle panel shows a left M1 MCA clot with grade 1 residual flow (A, yellow arrows, denser than surrounding brain parenchyma). The first angiogram shows excellent reperfusion (B and C). The bottom panel shows a left M1 MCA clot with grade 2 residual flow (A, yellow arrows, hairline or streak of well-defined contrast across the partial or complete length of the clot). The first angiogram shows excellent reperfusion (B and C).
- Fig 3.
Clot interface Hounsfield unit ratio calculated by measuring the Hounsfield units in a region of interest selected at the proximal and distal clot interface only in scans that are mid- to late arterial- or appropriate venous-weighted. cirHU is calculated by dividing the proximal clot interface Hounsfield unit by the distal clot interface Hounsfield unit. In A, a patient with a left M1 MCA clot has a cirHU of 1.05 while in B, a patient with a left M1 MCA clot has a cirHU of 3.21.
- Fig 4.
Tree representation of a recursive partitioning model (CART) predicting early reperfusion with IV tPA. Each subgroup (rectangle) has the percentage of subjects with early reperfusion (95% confidence interval). The number of subjects reperfused/number of subjects in each subgroup is italicized below each percentage. In all, 33/192 (17.19%) patients with ICA and M1 MCA clots achieved early reperfusion. Tree end points are highlighted in red. Splitting criteria and subgroup characteristics are described along each connecting line.
- Fig 5.
Clot location and length on baseline CTA along with early reperfusion (TICI 2a/2b/3) rates with IV tPA, final reperfusion (TICI 2b/3) at end of the IA procedure, and 90-day clinical outcome (mRS 0–2).
Tables
- Table 1:
Baseline demographics and CTA clot characteristics stratified by the 2 populations that form part of the overall study
Calgary CTA Data Base (n = 165) Keimyung Stroke Registry (n = 63) P Value Age (yr) (mean) 66.4 ± 14.3 69.5 ± 9.96 .12 Sex (male) (%) 49.1% 53.9% .5 Baseline NIHSS (median) (IQR) 18 (8) 14 (6) .01 Onset to IV tPA time (minutes) (median) (IQR) 112 (73) 125 (57) .18 IV tPA initiation to first angiography run time (minutes) (median) (IQR) 53 (45) 139 (75) .01 Site of occlusion (No.) (%) Carotid-T/-L 13 (8%) 1 (1.6%) .09 Tandem occlusions 38 (23%) 23 (36.5%) M1 MCA 86 (52.1%) 31 (49.2%) M2 MCA 28 (17%) 8 (12.7%) Very early arterial-weighted CTA (preclot HU < 150 and preclot HU ≥ HU at the torcula) (No.) (%) 0 (0%) 2 (3.2%) .07 Very late venous phase CTA (preclot HU < 150 and preclot HU < HU at the torcula) (No.) (%) 1 (0.6%) 2 (3.2%) .19 Residual flow (%) 21.8% 4.8% .01 Clot length (mm) (median) (IQR) 22.3 (34.5) 50 (30.6) .01 cirHU (median) (IQR) 1.5 (0.85) 2.8 (1.5) .01 M1 MCA origin to proximal clot interface distance (mm) (median) (IQR) 10.6 (7.6) 9.6 (11.3) .74 - Table 2:
Interrater reliability of various clot characteristics on CTA and TICI on first-run angiography (n = 30)
Clot Characteristics Agreement κ P Value Residual flow (grades 0, 1, 2) 86.7% 0.66 <.0001 Clot length (≤15 vs >15 mm) 100% 1 <.0001 Distance from M1 MCA origin (≤10 vs >10 mm) 100% 1 <.0001 cirHU ≥2 vs <2) 90% 0.78 <.0001 Early reperfusion with IV tPA (TICI 2a–3) 100% 1 <.0001
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