scholarly journals Noncontrast Computed Tomography e-Stroke Infarct Volume Is Similar to RAPID Computed Tomography Perfusion in Estimating Postreperfusion Infarct Volumes

Stroke ◽  
2021 ◽  
Vol 52 (2) ◽  
pp. 634-641 ◽  
Author(s):  
Mehdi Bouslama ◽  
Krishnan Ravindran ◽  
George Harston ◽  
Gabriel M. Rodrigues ◽  
Leonardo Pisani ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Odds Ratio ◽  
Functional Outcomes ◽  
Adjusted Odds Ratio ◽  
Infarct Volume ◽  
Tertiary Care ◽  
Computed Tomography Perfusion ◽  
Ischemic Core ◽  
Noncontrast Computed Tomography ◽  
Core Volume

Background and Purpose: The e-Stroke Suite software (Brainomix, Oxford, United Kingdom) is a tool designed for the automated quantification of The Alberta Stroke Program Early CT Score and ischemic core volumes on noncontrast computed tomography (NCCT). We sought to compare the prediction of postreperfusion infarct volumes and the clinical outcomes across NCCT e-Stroke software versus RAPID (IschemaView, Menlo Park, CA) computed tomography perfusion measurements. Methods: All consecutive patients with anterior circulation large vessel occlusion stroke presenting at a tertiary care center between September 2010 and November 2018 who had available baseline infarct volumes on both NCCT e-Stroke Suite software and RAPID CTP as well as final infarct volume (FIV) measurements and achieved complete reperfusion (modified Thrombolysis in Cerebral Infarction scale 2c-3) post-thrombectomy were included. The associations between estimated baseline ischemic core volumes and FIV as well as 90-day functional outcomes were assessed. Results: Four hundred seventy-nine patients met inclusion criteria. Median age was 64 years (55–75), median e-Stroke and computed tomography perfusion ischemic core volumes were 38.4 (21.8–58) and 5 (0–17.7) mL, respectively, whereas median FIV was 22.2 (9.1–56.2) mL. The correlation between e-Stroke and CTP ischemic core volumes was moderate (R=0.44; P <0.001). Similarly, moderate correlations were observed between e-Stroke software ischemic core and FIV (R=0.52; P <0.001) and CTP core and FIV (R=0.43; P <0.001). Subgroup analysis showed that e-Stroke software and CTP performance was similar in the early and late (>6 hours) treatment windows. Multivariate analysis showed that both e-Stroke software NCCT baseline ischemic core volume (adjusted odds ratio, 0.98 [95% CI, 0.97–0.99]) and RAPID CTP ischemic core volume (adjusted odds ratio, 0.98 [95% CI, 0.97–0.99]) were independently and comparably associated with good outcome (modified Rankin Scale score of 0–2) at 90 days. Conclusions: NCCT e-Stroke Suite software performed similarly to RAPID CTP in assessing postreperfusion FIV and functional outcomes for both early- and late-presenting patients. NCCT e-Stroke volumes seems to represent a viable alternative in centers where access to advanced imaging is limited. Moreover, the future development of fusion maps of NCCT and CTP ischemic core estimates may improve upon the current performance of these tools as applied in isolation.

Comparison of Two Automated Computed Tomography Perfusion Applications to Predict the Final Infarct Volume After Thrombolysis in Cerebral Infarction 3 Recanalization

Stroke ◽  
2021 ◽  
Author(s):  
Iris Muehlen ◽  
Maximilian Sprügel ◽  
Philip Hoelter ◽  
Stefan Hock ◽  
Michael Knott ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cerebral Infarction ◽  
Infarct Volume ◽  
Vessel Occlusion ◽  
Computed Tomography Perfusion ◽  
Software Applications ◽  
Ischemic Core ◽  
Mean Differences ◽  
Definition Of ◽  
Core Volume

Background and Purpose: Several automated computed tomography perfusion software applications have been developed to provide support in the definition of ischemic core and penumbra in acute ischemic stroke. However, the degree of interchangeability between software packages is not yet clear. Our study aimed to evaluate 2 commonly used automated perfusion software applications (Syngo.via and RAPID) for the indication of ischemic core with respect to the follow-up infarct volume (FIV) after successful recanalization and with consideration of the clinical impact. Methods: Retrospectively, 154 patients with large vessel occlusion of the middle cerebral artery or the internal carotid artery, who underwent endovascular therapy with a consequent Thrombolysis in Cerebral Infarction 3 result within 2 hours after computed tomography perfusion, were included. Computed tomography perfusion core volumes were assessed with both software applications with different thresholds for relative cerebral blood flow (rCBF). The results were compared with the FIV on computed tomography within 24 to 36 hours after recanalization. Bland-Altman was applied to display the levels of agreement and to evaluate systematic differences. Results: Highest correlation between ischemic core volume and FIV without significant differences was found at a threshold of rCBF<38% for the RAPID software ( r =0.89, P <0.001) and rCBF<25% for the Syngo software ( r =0.87, P <0.001). Bland-Altman analysis revealed best agreement in these settings. In the vendor default settings (rCBF<30% for RAPID and rCBF<20% for Syngo) correlation between ischemic core volume and FIV was also high (RAPID: r =0.88, Syngo: r =0.86, P <0.001), but mean differences were significant ( P <0.001). The risk of critical overestimation of the FIV was higher with rCBF<38% (RAPID) and rCBF<25% (Syngo) than in the default settings. Conclusions: By adjusting the rCBF thresholds, comparable results with reliable information on the FIV after complete recanalization can be obtained both with the RAPID and Syngo software. Keeping the software specific default settings means being more inclusive in patient selection, but forgo the highest possible accuracy in the estimation of the FIV.

scholarly journals Ischemic Core Overestimation on Computed Tomography Perfusion

Stroke ◽  
2021 ◽  
Author(s):  
Álvaro García-Tornel ◽  
Daniel Campos ◽  
Marta Rubiera ◽  
Sandra Boned ◽  
Marta Olivé-Gadea ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Intensity Ratio ◽  
Adjusted Odds Ratio ◽  
Infarct Volume ◽  
Residue Function ◽  
Interquartile Range ◽  
Large Vessel ◽  
Imaging Time ◽  
Ischemic Core ◽  
Large Vessel Stroke

Background and Purpose: Different studies have pointed that CT perfusion (CTP) could overestimate ischemic core in early time window. We aim to evaluate the influence of time and collateral status on ischemic core overestimation. Methods: Retrospective single-center study including patients with anterior circulation large-vessel stroke that achieved reperfusion after endovascular treatment. Ischemic core and collateral status were automatically estimated on baseline CTP using commercially available software. CTP-derived core was considered as tissue with a relative reduction of cerebral blood flow <30%, as compared with contralateral hemisphere. Collateral status was assessed using the hypoperfusion intensity ratio (defined by the proportion of the time to maximum of tissue residue function >6 seconds with time to maximum of tissue residue function >10 seconds). Final infarct volume was measured on 24 to 48 hours noncontrast CT. Ischemic core overestimation was considered when CTP-derived core was larger than final infarct. Results: Four hundred and seven patients were included in the analysis. Median CTP-derived core and final infarct volume were 7 mL (interquartile range, 0–27) and 20 mL (interquartile range, 5–55), respectively. Median hypoperfusion intensity ratio was 0.46 (interquartile range, 0.23–0.59). Eighty-three patients (20%) presented ischemic core overestimation (median overestimation, 12 mL [interquartile range, 41–5]). Multivariable logistic regression analysis adjusted by CTP-derived core and confounding variables showed that poor collateral status (per 0.1 hypoperfusion intensity ratio increase; adjusted odds ratio, 1.41 [95% CI, 1.20–1.65]) and earlier onset to imaging time (per 60 minutes earlier; adjusted odds ratio, 1.14 [CI, 1.04–1.25]) were independently associated with core overestimation. No significant association was found with imaging to reperfusion time (per 30 minutes earlier; adjusted odds ratio, 1.17 [CI, 0.96–1.44]). Poor collateral status influence on core overestimation differed according to onset to imaging time, with a stronger size of effect on early imaging patients( P interaction <0.01). Conclusions: In patients with large-vessel stroke that achieve reperfusion after endovascular therapy, poor collateral status might induce higher rates of ischemic core overestimation on CTP, especially in patients in earlier window time. CTP reflects a hemodynamic state rather than tissue fate; collateral status and onset to imaging time are important factors to consider when estimating core on CTP.

scholarly journals Ghost Infarct Core and Admission Computed Tomography Perfusion: Redefining the Role of Neuroimaging in Acute Ischemic Stroke

2018 ◽  
Vol 7 (6) ◽  
pp. 513-521 ◽  
Author(s):  
Nuno Martins ◽  
Ana Aires ◽  
Beatriz Mendez ◽  
Sandra Boned ◽  
Marta Rubiera ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cerebral Blood Volume ◽  
Time Window ◽  
Infarct Volume ◽  
Early Time ◽  
Infarct Core ◽  
Computed Tomography Perfusion ◽  
Noncontrast Ct ◽  
Adjusted Logistic Regression ◽  
Core Volume

Background: Determining the size of infarct extent is crucial to elect patients for reperfusion therapies. Computed tomography perfusion (CTP) based on cerebral blood volume may overestimate infarct core on admission and consequently include ghost infarct core (GIC) in a definitive lesional area. Purpose: Our goal was to confirm and better characterize the GIC phenomenon using CTP cerebral blood flow (CBF) as the reference parameter to determine infarct core. Methods: We performed a retrospective, single-center analysis of consecutive thrombectomies of middle cerebral or intracranial internal carotid artery occlusions considering noncontrast CT Alberta Stroke Program Early CT Score ≥6 in patients with pretreatment CTP. We used the RAPID® software to measure admission infarct core based on initial CBF. The final infarct was extracted from follow-up CT. GIC was defined as initial core minus final infarct > 10 mL. Results: A total of 123 patients were included. The median National Institutes of Health Stroke Scale score was 18 (13–20), the median time from symptoms to CTP was 188 (67–288) min, and the recanalization rate (Thrombolysis in Cerebral Infarction score 2b, 2c, or 3) was 83%. Twenty patients (16%) presented with GIC. GIC was associated with shorter time to recanalization (150 [105–291] vs. 255 [163–367] min, p = 0.05) and larger initial CBF core volume (38 [26–59] vs. 6 [0–27] mL, p < 0.001). An adjusted logistic regression model identified time to recanalization < 302 min (OR 4.598, 95% CI 1.143–18.495, p = 0.032) and initial infarct volume (OR 1.01, 95% CI 1.001–1.019, p = 0.032) as independent predictors of GIC. At 24 h, clinical improvement was more frequent in patients with GIC (80 vs. 49%, p = 0.01). Conclusions: CTP CBF < 30% may overestimate infarct core volume, especially in patients imaged in the very early time window and with fast complete reperfusion. Therefore, the CTP CBF technique may exclude patients who would benefit from endovascular treatment.

scholarly journals The accuracy of ischemic core perfusion thresholds varies according to time to recanalization in stroke patients treated with mechanical thrombectomy: A comprehensive whole-brain computed tomography perfusion study

2019 ◽  
Vol 40 (5) ◽  
pp. 966-977 ◽  
Author(s):  
Carlos Laredo ◽  
Arturo Renú ◽  
Raúl Tudela ◽  
Antonio Lopez-Rueda ◽  
Xabier Urra ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Mechanical Thrombectomy ◽  
Infarct Volume ◽  
Intraclass Correlation ◽  
Stroke Patients ◽  
Perfusion Study ◽  
Computed Tomography Perfusion ◽  
Ischemic Core ◽  
Perfusion Maps

Computed tomography perfusion (CTP) allows the estimation of pretreatment ischemic core after acute ischemic stroke. However, CTP-derived ischemic core may overestimate final infarct volume. We aimed to evaluate the accuracy of CTP-derived ischemic core for the prediction of final infarct volume according to time from stroke onset to recanalization in 104 patients achieving complete recanalization after mechanical thrombectomy who had a pretreatment CTP and a 24-h follow-up MRI-DWI. A range of CTP thresholds was explored in perfusion maps at constant increments for ischemic core calculation. Time to recanalization modified significantly the association between ischemic core and DWI lesion in a non-linear fashion ( p-interaction = 0.018). Patients with recanalization before 4.5 h had significantly lower intraclass correlation coefficient (ICC) values between CTP-predicted ischemic core and DWI lesion ( n = 54; best threshold relative cerebral blood flow (rCBF) < 25%, ICC = 0.673, 95% CI = 0.495–0.797) than those with later recanalization ( n = 50; best threshold rCBF < 30%, ICC = 0.887, 95% CI = 0.811–0.935, p = 0.013), as well as poorer spatial lesion agreement. The significance of the associations between CTP-derived ischemic core and clinical outcome at 90 days was lost in patients recanalized before 4.5 h. CTP-derived ischemic core must be interpreted with caution given its dependency on time to recanalization, primarily in patients with higher chances of early recanalization.

scholarly journals Volumetric and Spatial Accuracy of Computed Tomography Perfusion Estimated Ischemic Core Volume in Patients With Acute Ischemic Stroke

Stroke ◽  
2018 ◽  
Vol 49 (10) ◽  
pp. 2368-2375 ◽  
Author(s):  
Jan W. Hoving ◽  
Henk A. Marquering ◽  
Charles B.L.M. Majoie ◽  
Nawaf Yassi ◽  
Gagan Sharma ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Spatial Accuracy ◽  
Computed Tomography Perfusion ◽  
Ischemic Core ◽  
Core Volume

Abstract P331: Accuracy of CT Perfusion Core Estimates for Predicting Infarct Size in the SELECT Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Amrou Sarraj ◽  
Bruce Campbell ◽  
Clark Sitton ◽  
Soren Christensen ◽  
Shekhar Khanpara ◽  
...  
Keyword(s):  
Cohort Study ◽  
White Matter ◽  
Infarct Size ◽  
Ct Perfusion ◽  
Infarct Volume ◽  
Estimation Accuracy ◽  
Ct Perfusion Imaging ◽  
Ischemic Core ◽  
The Difference ◽  
Core Volume

Background: The accuracy of CT perfusion imaging for estimating the ischemic core has been questioned. Methods: In SELECT, a prospective cohort study of imaging selection, pts who achieved complete reperfusion after EVT were stratified on time from LKW to imaging acquisition and time from imaging to reperfusion. The difference between baseline CTP core volume and f/up infarct volume (on DWI after EVT) was classified as over-estimation (core >10 cc larger than infarct), adequate, or under-estimation (≥ 25 cc smaller). F/up DWI lesion was outlined using a semiautomated algorithm and co-registered to CTP. Results: Of 361 enrolled, 117 achieved TICI 3. F/up MRIs were acquired at 21 (13-30) hrs from EVT with median infarct volume of 16.4 cc, median 8.1 cc larger than baseline core. Median (IQR) time from imaging acquisition to groin puncture (GP) was 70 (50-95) min. Reperfusion was achieved at 35 (25-54) min of GP. The frequency of overestimation decreased as time LKW to imaging increased: < 90 min 6 (14%), 90 – 270 min 3 (6%) and > 270 min 1 (4%), and adequate estimation increased (< 90 min 21 (50%), 90 – 270 min 32 (65%) and > 270min 19 (73%), p for trend 0.048) Fig 1. Overestimation primarily occurred in pts imaged within 90 min who had short imaging to reperfusion times Fig 2. Volumetric correlation between pre-procedure and f/up imaging improved as LKW time to imaging acquisition increased; Spearman’s ρ: <90 min: 0.41 (p=0.007), 90-270 min: 0.35 (p=0.01), >270 min: 0.79 (p<0.0001). Spatially, overestimation occurred predominantly in white matter juxtacortical areas. Adjusting rCBF threshold from < 30% to < 20% in the 6 pts with overestimation ≤ 90 min from LKW resulted in adequate core estimation in all 6, Fig 3. Conclusion: In patients who achieve reperfusion, the correlation between baseline CTP ischemic core volume and f/up DWI volume improved as time LKW to imaging increased. Core estimation accuracy improved by using the < 20% CBF threshold for patients imaged within 90 minutes of LKW.

Abstract P362: A Volumetric Comparison of Computed Tomography Perfusion Rapid Core Volume in Different Time Frames With Diffusion-Weighted Imaging Infarct Volume in the Post-Thrombectomy Patients After Large Vessel Occlusion

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Riwaj Bhagat ◽  
Krishna Madireddy ◽  
Shivani Naik ◽  
Gopika Kutty ◽  
Wei Liu
Keyword(s):  
Symptom Onset ◽  
Diffusion Weighted Imaging ◽  
Infarct Volume ◽  
Time Frame ◽  
Large Vessel Occlusion ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Computed Tomography Perfusion ◽  
Time Frames ◽  
Core Volume

Introduction: The Computed Tomography Perfusion (CTP) RAPID software is widely used for the patient selection for mechanical thrombectomy (MT) after anterior circulation large vessel occlusion (LVO). There is a notion that it overestimates the core volume (CV) in an earlier time frame from symptom onset. We compared the accuracy of CTP RAPID estimated CV in different time frames with diffusion weighted imaging (DWI) infarct volume (IV). Method: A retrospective data review of patients who underwent MT for anterior circulation LVO with TICI 2b/3 reperfusion from 2017 to 2019 was done. Patients with baseline CTP and follow up 36-hour MRI was included. Patients with parenchymal hematoma, graded as per ECASS II classification were excluded. CTP time was dichotomized as 0-3 hours (hrs) and >3 hrs from symptom onset. DWI IV was calculated by ABC/2 formula. The volumetric difference (VD), defined as DWI IV minus CTP CV, core volume overestimation (CVO), defined as CTP CV minus DWI IV and CT ASPECTS was calculated. Large CV was defined as >50 ml CV. Standard descriptive statistics and independent sample T-test were used as statistical tools. Result: Total MT cases (n) were 61. Mean age (y.o) was 66 (SD 13.9) (male 57.4%). In < 3 hrs from symptom onset (n 27), mean CTP CV was 38.8 ml (SD 39.8), DWI IV was 39.6 ml (SD 51.4), VD was 0.9 ml (SD 55.2) (p 0.945) and CVO (n 11) was 39.6 ml (SD 35.7) (p 0.008). Mean large CV (n 8) was 78.3 ml (SD 25.4) with median CT ASPECTS of 8 (IQR 6.5-9) and median mRS at discharge 2 (IQR 0.8- 3.3). In >3 hrs from symptom onset (n 34), mean CTP CV was 28.81 ml (SD 47.4), DWI IV was 75.3 ml (SD 69.5), VD was 46.5 ml (SD 61.8) (p 0.002) and CVO (n 5) was 25.2 ml (SD 41.27) (p 0.60). Mean large CV (n 5) was 116.8 ml (SD 75.3) with median CT ASPECTS of 6 (IQR 5-7) and median mRS at discharge 5 (IQR 4- 6). Conclusion: Overestimated core volume on CTP was seen in more than one third cases within 3 hours from symptom onset. Large CV estimated within this time frame had higher CT ASPECTS and good functional outcome at discharge.

scholarly journals e-ASPECTS derived acute ischemic volumes on non-contrast-enhanced computed tomography images

2019 ◽  
Vol 15 (9) ◽  
pp. 995-1001
Author(s):  
Simon Nagel ◽  
Olivier Joly ◽  
Johannes Pfaff ◽  
Panagiotis Papanagiotou ◽  
Klaus Fassbender ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Clinical Outcome ◽  
Diffusion Weighted Imaging ◽  
Clinical Severity ◽  
Stroke Severity ◽  
Lesion Volume ◽  
Computed Tomography Perfusion ◽  
Computed Tomography Images ◽  
Diffusion Weighted ◽  
Ischemic Core

Background and purpose Validation of automatically derived acute ischemic volumes (AAIV) from e-ASPECTS on non-contrast computed tomography (NCCT). Materials and methods Data from three studies were reanalyzed with e-ASPECTS Version 7. AAIV was calculated in milliliters (ml) in all scored ASPECTS regions of the hemisphere detected by e-ASPECTS. The National Institute of Health Stroke Scale (NIHSS) determined stroke severity at baseline and clinical outcome was measured with the modified Rankin Scale (mRS) between 45 and 120 days. Spearman ranked correlation coefficients (R) of AAIV and e-ASPECTS scores with NIHSS and mRS as well as Pearson correlation of AAIV with diffusion-weighted imaging and CT perfusion-estimated ischemic “core” volumes were calculated. Multivariate regression analysis (odds ratio, OR with 95% confidence intervals, CI) and Bland–Altman plots were performed. Results We included 388 patients. Mean AAIV was 11.6 ± 18.9 ml and e-ASPECTS was 9 (8–10: median and interquartile range). AAIV, respectively e-ASPECTS correlated with NIHSS at baseline (R = 0.35, p < 0.001; R = −0.36, p < 0.001) and follow-up mRS (R = 0.29, p < 0.001; R = −0.3, p < 0.001). In subsets of patients, AAIV correlated strongly with diffusion-weighted imaging ( n = 37, R = 0.68, p < 0.001) and computed tomography perfusion-derived ischemic “core” ( n = 41, R = 0.76, p < 0.001) lesion volume and Bland–Altman plots showed a bias close to zero (−2.65 ml for diffusion-weighted imaging and 0.45 ml forcomputed tomography perfusion “core”). Within the whole cohort, the AAIV (OR 0.98 per ml, 95% CI 0.96–0.99) and e-ASPECTS scores (OR 1.3, 95%CI 1.07–1.57) were independent predictors of good outcome Conclusion AAIV on NCCT correlated moderately with clinical severity but strongly with diffusion-weighted imaging lesion and computed tomography perfusion ischemic “core” volumes and predicted clinical outcome.

scholarly journals Thrombus Migration and Fragmentation After Intravenous Alteplase Treatment

Stroke ◽  
2021 ◽  
Vol 52 (1) ◽  
pp. 203-212
Author(s):  
Tomoyuki Ohara ◽  
Bijoy K. Menon ◽  
Fahad S. Al-Ajlan ◽  
MacKenzie Horn ◽  
Mohamed Najm ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Carotid Artery ◽  
Clinical Outcome ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Internal Carotid ◽  
Artery Occlusion ◽  
Intravenous Alteplase ◽  
Over Time

Background and Purpose: There is interest in what happens over time to the thrombus after intravenous alteplase. We study the effect of alteplase on thrombus structure and its impact on clinical outcome in patients with acute stroke. Methods: Intravenous alteplase treated stroke patients with intracranial internal carotid artery or middle cerebral artery occlusion identified on baseline computed tomography angiography and with follow-up vascular imaging (computed tomography angiography or first run of angiography before endovascular therapy) were enrolled from INTERRSeCT study (Identifying New Approaches to Optimize Thrombus Characterization for Predicting Early Recanalization and Reperfusion With IV Alteplase and Other Treatments Using Serial CT Angiography). Thrombus movement after intravenous alteplase was classified into complete recanalization, thrombus migration, thrombus fragmentation, and no change. Thrombus migration was diagnosed when occlusion site moved distally and graded according to degrees of thrombus movement (grade 0–3). Thrombus fragmentation was diagnosed when a new distal occlusion in addition to the primary occlusion was identified on follow-up imaging. The association between thrombus movement and clinical outcome was also evaluated. Results: Among 427 patients in this study, thrombus movement was seen in 54% with a median time of 123 minutes from alteplase administration to follow-up imaging, and sub-classified as marked (thrombus migration grade 2–3 + complete recanalization; 27%) and mild to moderate thrombus movement (thrombus fragmentation + thrombus migration grade 0–1; 27%). In patients with proximal M1/internal carotid artery occlusion, marked thrombus movement was associated with a higher rate of good outcome (90-day modified Rankin Scale, 0–2) compared with mild to moderate movement (52% versus 27%; adjusted odds ratio, 5.64 [95% CI, 1.72–20.10]). No difference was seen in outcomes between mild to moderate thrombus movement and no change. In M1 distal/M2 occlusion, marked thrombus movement was associated with improved 90-day good outcome compared with no change (70% versus 56%; adjusted odds ratio, 2.54 [95% CI, 1.21–5.51]). Conclusions: Early thrombus movement is common after intravenous alteplase. Marked thrombus migration leads to good clinical outcomes. Thrombus dynamics over time should be further evaluated in clinical trials of acute reperfusion therapy.

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