Thrombus Migration and Fragmentation After Intravenous Alteplase Treatment

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