Adnan Mujanovic, Daniel Windecker, Bettina Serrallach, Christoph C Kurmann, Roman Rohner, Elias Auer, Petra Cimflova, Thomas R Meinel, Franziska Dorn, René Chapot, David Seiffge, Eike Immo I Piechowiak, Tomas Dobrocky, Jan Gralla, Urs Fischer, Sara Pilgram-Pastor, Johannes Kaesmacher
{"title":"DOT 征表明血栓切除术后再灌注不完全的患者会出现持续的低灌注和不良预后。","authors":"Adnan Mujanovic, Daniel Windecker, Bettina Serrallach, Christoph C Kurmann, Roman Rohner, Elias Auer, Petra Cimflova, Thomas R Meinel, Franziska Dorn, René Chapot, David Seiffge, Eike Immo I Piechowiak, Tomas Dobrocky, Jan Gralla, Urs Fischer, Sara Pilgram-Pastor, Johannes Kaesmacher","doi":"10.1136/jnis-2024-022253","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5000,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"DOT sign indicates persistent hypoperfusion and poor outcome in patients with incomplete reperfusion following thrombectomy.\",\"authors\":\"Adnan Mujanovic, Daniel Windecker, Bettina Serrallach, Christoph C Kurmann, Roman Rohner, Elias Auer, Petra Cimflova, Thomas R Meinel, Franziska Dorn, René Chapot, David Seiffge, Eike Immo I Piechowiak, Tomas Dobrocky, Jan Gralla, Urs Fischer, Sara Pilgram-Pastor, Johannes Kaesmacher\",\"doi\":\"10.1136/jnis-2024-022253\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":16411,\"journal\":{\"name\":\"Journal of NeuroInterventional Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":4.5000,\"publicationDate\":\"2024-09-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of NeuroInterventional Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1136/jnis-2024-022253\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"NEUROIMAGING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of NeuroInterventional Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/jnis-2024-022253","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"NEUROIMAGING","Score":null,"Total":0}
DOT sign indicates persistent hypoperfusion and poor outcome in patients with incomplete reperfusion following thrombectomy.
Background: Distal occlusions associated with incomplete reperfusion (expanded Thrombolysis in Cerebral Infarction,
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).
期刊介绍：
The Journal of NeuroInterventional Surgery (JNIS) is a leading peer review journal for scientific research and literature pertaining to the field of neurointerventional surgery. The journal launch follows growing professional interest in neurointerventional techniques for the treatment of a range of neurological and vascular problems including stroke, aneurysms, brain tumors, and spinal compression.The journal is owned by SNIS and is also the official journal of the Interventional Chapter of the Australian and New Zealand Society of Neuroradiology (ANZSNR), the Canadian Interventional Neuro Group, the Hong Kong Neurological Society (HKNS) and the Neuroradiological Society of Taiwan.
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