DOT sign indicates persistent hypoperfusion and poor outcome in patients with incomplete reperfusion following thrombectomy

医学 灌注 溶栓 优势比 灌注扫描 闭塞 置信区间 放射科 回顾性队列研究 改良兰金量表 心脏病学 缺血 内科学 外科 心肌梗塞 缺血性中风
作者
Adnan Mujanović,Daniel Windecker,Bettina L. Serrallach,Christoph C. Kurmann,Roman Rohner,Elias Auer,Petra Cimflová,Thomas R. Meinel,Franziska Dorn,René Chapot,David Seiffge,Eike I. Piechowiak,Tomas Dobrocky,Jan Gralla,Urs Fischer,Sara Pilgram‐Pastor,Johannes Kaesmacher
出处
期刊:Journal of NeuroInterventional Surgery [BMJ]
卷期号:: jnis-022253
标识
DOI:10.1136/jnis-2024-022253
摘要

Background Distal occlusions associated with incomplete reperfusion (expanded Thrombolysis in Cerebral Infarction, <eTICI 3) may not reperfuse spontaneously and thus prompt ischemia (ie, persistent hypoperfusion). We aimed to assess whether the recently reported Distal Occlusion Tracker (DOT) sign on immediate non-contrast post-interventional flat-panel detector computed tomography (FPDCT) is associated with persistent hypoperfusion. Methods Retrospective registry analysis of patients undergoing endovascular therapy between July 2020 and December 2022, with available immediate post-interventional FPDCT and 24 hours follow-up perfusion imaging. Persistent hypoperfusion was defined as a perfusion deficit at 24 hours directly corresponding to the area of incomplete reperfusion on final angiography run. The DOT sign was defined as a punctiform or tubular hyperdense signal increase on FPDCT indicative of a residual occlusion. Association between the DOT sign (present/absent) with the occurrence of persistent hypoperfusion and poor outcome (modified Rankin scale (mRS) score 3–6) was evaluated using logistic regression analysis. Results Of 292 patients included (median age 73 years; 47% female), 209 had incomplete reperfusion. Among patients with incomplete reperfusion, 61% had a present DOT sign and 46% had persistent hypoperfusion. In the overall cohort, but also within each eTICI stratum, a present DOT sign was associated with persistent hypoperfusion on 24±12 hours follow-up perfusion imaging (adjusted odds ratio (aOR) 4.8, 95% confidence interval (CI) 2.0 to 12.3 for patients with eTICI 2 a-2c). A present DOT sign was also associated with poor outcome (aOR 2.6, 95% CI 1.1 to 6.2). Conclusion Patients with <eTICI 3 and a present DOT sign have a higher likelihood of persistent hypoperfusion and might constitute a subgroup that could particularly benefit from additional reperfusion attempts.

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