Estimating the number of UK stroke patients eligible for endovascular thrombectomy

Introduction Endovascular thrombectomy is a highly effective treatment for acute ischemic stroke due to large arterial occlusion. Routine provision will require major changes in service configuration and workforce. An important first step is to quantify the population of stroke patients that could benefit. We estimated the annual UK population suitable for endovascular thrombectomy using standard or advanced imaging for patient selection. Patients and methods Evidence from randomised control trials and national registries was combined to estimate UK stroke incidence and define a decision-tree describing the endovascular thrombectomy eligible population. Results Between 9620 and 10,920 UK stroke patients (approximately 10% of stroke admissions) would be eligible for endovascular thrombectomy annually. The majority (9140–9620) would present within 4 h of onset and be suitable for intravenous thrombolysis. Advanced imaging would exclude 500 patients presenting within 4 h, but identify an additional 1310 patients as eligible who present later. Discussion Information from randomised control trials and large registry data provided the evidence criterion for 9 of the 12 decision points. The best available evidence was used for two decision points with sensitivity analyses to determine how key branches of the tree affected estimates. Using the mid-point estimate for eligibility (9.6% of admissions) and assuming national endovascular thrombectomy coverage, 4280 patients would have reduced disability. Conclusion A model combining published trials and register data suggests approximately 10% of all stroke admissions in the UK are eligible for endovascular thrombectomy. The use of advanced imaging based on current published evidence did not have a major impact on overall numbers but could alter eligibility status for 16% of cases.

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Low stroke incidence in the TEMPiS telestroke network during COVID-19 pandemic – effect of lockdown on thrombolysis and thrombectomy

Journal of Telemedicine and Telecare ◽

10.1177/1357633x20943327 ◽

2020 ◽

pp. 1357633X2094332 ◽

Cited By ~ 2

Author(s):

Felix Schlachetzki ◽

Carmen Theek ◽

Nikolai D Hubert ◽

Mustafa Kilic ◽

Roman L Haberl ◽

...

Keyword(s):

Rebound Effect ◽

Intravenous Thrombolysis ◽

Stroke Care ◽

Population Mobility ◽

Stroke Patients ◽

Stroke Incidence ◽

Endovascular Thrombectomy ◽

Exact Test ◽

Mobility Data ◽

Ap Value

Background During the COVID-19 pandemic emergency departments have noted a significant decrease in stroke patients. We performed a timely analysis of the Bavarian telestroke TEMPiS “working diagnosis” database. Methods Twelve hospitals from the TEMPiS network were selected. Data collected for January through April in years 2017 through 2020 were extracted and analyzed for presumed and definite ischemic stroke (IS), amongst other disorders. In addition, recommendations for intravenous thrombolysis (rtPA) and endovascular thrombectomy (EVT) were noted and mobility data of the region analyzed. If statistically valid, group-comparison was tested with Fisher’s exact test considering unpaired observations and ap-value < 0.05 was considered significant. Results Upon lockdown in mid-March 2020, we observed a significant reduction in recommendations for rtPA compared to the preceding three years (14.7% [2017–2019] vs. 9.2% [2020], p = 0.0232). Recommendations for EVT were significantly higher in January to mid-March 2020 compared to 2017–2019 (5.4% [2017–2019] vs. 9.3% [2020], p = 0.0013) reflecting its increasing importance. Following the COVID-19 lockdown mid-March 2020 the number of EVT decreased back to levels in 2017–2019 (7.4% [2017–2019] vs. 7.6% [2020], p = 0.1719). Absolute numbers of IS decreased in parallel to mobility data. Conclusions The reduced stroke incidence during the COVID-19 pandemic may in part be explained by patient avoidance to seek emergency stroke care and may have an association to population mobility. Increasing mobility may induce a rebound effect and may conflict with a potential second COVID-19 wave. Telemedical networks may be ideal databases to study such effects in near-real time.

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Updating estimates of the number of UK stroke patients eligible for endovascular thrombectomy: incorporating recent evidence to facilitate service planning

European Stroke Journal ◽

10.1177/23969873211059471 ◽

2021 ◽

pp. 239698732110594

Author(s):

Peter McMeekin ◽

Darren Flynn ◽

Martin James ◽

Christopher I Price ◽

Gary A Ford ◽

...

Keyword(s):

Decision Tree ◽

Service Planning ◽

Sensitivity Analyses ◽

Ageing Population ◽

Demographic Changes ◽

Stroke Patients ◽

Advanced Imaging ◽

Ongoing Research ◽

Endovascular Thrombectomy ◽

Eligible Population

Introduction Endovascular thrombectomy (EVT) is a highly effective treatment for acute ischaemic stroke due to large arterial occlusion (LAO). To support decisions about service provision, we previously estimated the annual UK population eligible for EVT as ∼10% of stroke admissions. Since then, several trials have produced evidence that could alter these figures. We update our estimates considering information from studies and trials reporting 2018–2021 on incidence, presentation time and stroke severity and consider the possible impact of predicted demographic changes in the next 10–20 years. Patients and Methods We produce an updated decision tree describing the EVT eligible population for UK stroke admissions. One-way sensitivity analyses (using upper and lower confidence intervals for estimates at each branch of our decision tree) were used to identify where further research evidence is necessary to increase certainty around estimates for numbers of EVT eligible patients. Results The updated estimate for the number of UK stroke patients eligible for EVT annually was between 10,020 (no advanced imaging in early presenting patients) and 9,580 (advanced imaging in all early presenting patients), which compared with our estimates in 2017 is a minimal reduction. One-way sensitivity analyses established that enhanced evidence about eligibility for milder strokes, ASPECTS scores and pre-stroke disability are offset by evidence regarding a lower incidence of LAO. Importantly, predicted increases in life expectancy by 2040 may increase thrombectomy need by 40%. Discussion Information from additional randomised trials published during 2018–2020 with updated estimates of LAO prevalence had a minimal impact on overall estimates of stroke patients eligible for EVT in the UK. Ongoing research into the benefits of EVT for patients with mild stroke or European Stroke Journal For Peer Review lower ASPECTS scores has the potential to increase the estimates of the eligible population; future need for EVT will increase with the ageing population. Conclusion Our updated analyses show overall numbers eligible little changed, but evidence from ongoing trials and demographic changes have the potential to increase the need for EVT significantly.

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Intravenous Thrombolysis Is Associated with Less Disabling Stroke and Lower Mortality in Multiple-Pass Endovascular Thrombectomy

Cerebrovascular Diseases ◽

10.1159/000512105 ◽

2021 ◽

pp. 1-6

Author(s):

Christopher Blair ◽

Leon Edwards ◽

Cecilia Cappelen-Smith ◽

Dennis Cordato ◽

Andrew Cheung ◽

...

Keyword(s):

Multivariate Analysis ◽

Acute Ischaemic Stroke ◽

Intravenous Thrombolysis ◽

Additional Benefit ◽

Modified Rankin Scale ◽

Stroke Patients ◽

Anterior Circulation ◽

Endovascular Thrombectomy ◽

Multiple Pass ◽

First Pass

Background and Purpose: The benefit of bridging intravenous thrombolysis (IVT) in acute ischaemic stroke patients eligible for endovascular thrombectomy (EVT) is unclear. This may be particularly relevant where reperfusion is achieved with multiple thrombectomy passes. We aimed to determine the benefit of bridging IVT in first and multiple-pass patients undergoing EVT ≤6 h from stroke onset to groin puncture. Methods: We compared 90-day modified Rankin Scale (mRS) outcomes in 187 consecutive patients with large vessel occlusions (LVOs) of the anterior cerebral circulation who underwent EVT ≤6 h from symptom onset and who achieved modified thrombolysis in cerebral ischaemia (mTICI) 2c/3 reperfusion with the first pass to those patients who required multiple passes to achieve reperfusion. The effect of bridging IVT on outcomes was examined. Results: Significantly more first-pass patients had favourable (mRS 0–2) 90-day outcomes (68 vs. 42%, p = 0.001). Multivariate analysis showed an association between first-pass reperfusion and favourable outcomes (OR 2.25; 95% CI 1.08–4.68; p = 0.03). IVT provided no additional benefit in first-pass patients (OR 1.17; CI 0.42–3.20; p = 0.76); however, in multiple-pass patients, it reduced the risk of disabling stroke (mRS ≥4) (OR 0.30; CI 0.10–0.88; p = 0.02) and mortality (OR 0.07; CI 0.01–0.36; p = 0.002) at 90 days. Conclusion: Bridging IVT may benefit patients with anterior circulation stroke with LVO who qualify for EVT and who require multiple passes to achieve reperfusion.

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Early NT-ProBNP (N-Terminal Probrain Natriuretic Peptide) Elevation Predicts Malignant Edema and Death After Reperfusion Therapy in Acute Ischemic Stroke Patients

Stroke ◽

10.1161/strokeaha.120.029593 ◽

2021 ◽

Author(s):

Xuting Zhang ◽

Shenqiang Yan ◽

Wansi Zhong ◽

Yannan Yu ◽

Min Lou

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Natriuretic Peptide ◽

Odds Ratio ◽

Intravenous Thrombolysis ◽

Reperfusion Therapy ◽

Stroke Patients ◽

Endovascular Thrombectomy ◽

Median Serum ◽

The Relationship

Background and Purpose: We aimed to investigate the relationship between early NT-proBNP (N-terminal probrain natriuretic peptide) and all-cause death in patients receiving reperfusion therapy, including intravenous thrombolysis and endovascular thrombectomy (EVT). Methods: This study included 1039 acute ischemic stroke patients with early NT-proBNP data at 2 hours after the beginning of alteplase infusion for those with intravenous thrombolysis only or immediately at the end of EVT for those with EVT. We performed natural log transformation for NT-proBNP (Ln(NT-proBNP)). Malignant brain edema was ascertained by using the SITS-MOST (Safe Implementation of Thrombolysis in Stroke-Monitoring Study) criteria. Results: Median serum NT-proBNP level was 349 pg/mL (interquartile range, 89–1250 pg/mL). One hundred twenty-one (11.6%) patients died. Malignant edema was observed in 78 (7.5%) patients. Ln(NT-proBNP) was independently associated with 3-month mortality in patients with intravenous thrombolysis only (odds ratio, 1.465 [95% CI, 1.169–1.836]; P =0.001) and in those receiving EVT (odds ratio, 1.563 [95% CI, 1.139–2.145]; P =0.006). The elevation of Ln(NT-proBNP) was also independently associated with malignant edema in patients with intravenous thrombolysis only (odds ratio, 1.334 [95% CI, 1.020–1.745]; P =0.036), and in those with EVT (odds ratio, 1.455 [95% CI, 1.057–2.003]; P =0.022). Conclusions: An early increase in NT-proBNP levels was related to malignant edema and stroke mortality after reperfusion therapy.

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Abstract TP62: Frequency, Characteristics, and Outcomes of Acute Ischemic Stroke Patients With “Total Mismatch” on Penumbral Imaging Before Reperfusion Therapy

Stroke ◽

10.1161/str.51.suppl_1.tp62 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Hai Jui CHU ◽

David Liebeskind ◽

Yannan Yu ◽

Bryan Yoo ◽

Latisha Sharma ◽

...

Keyword(s):

Intravenous Thrombolysis ◽

Reperfusion Therapy ◽

Frequency Characteristics ◽

Lesion Volume ◽

Therapy Outcomes ◽

Stroke Patients ◽

Anterior Circulation ◽

Endovascular Thrombectomy ◽

Penumbral Imaging ◽

Acute Cerebral Ischemia

Background: When penumbral imaging shows “total mismatch” (large perfusion lesion and no irreversibly infarcted core), the entirety of jeopardized brain is still salvageable and the benefits of reperfusion therapy may be enhanced. The frequency, characteristics, and reperfusion therapy outcomes of total mismatch patients has not been well-characterized. Methods: Analysis of consecutive acute cerebral ischemia patients in anterior circulation undergoing CT or MR penumbral imaging prior to intravenous thrombolysis (IVT) and/or endovascular thrombectomy (EVT). Patients were classified in four groups: 1) total mismatch (core 0% of perfusion lesion), 2) non-total but substantial mismatch (core 1-20% of perfusion lesion), 3) moderate or no mismatch (core 20-100% of perfusion lesion), and 4) small perfusion lesion (perfusion lesion volume <10 ml). Results: Among 180 patients, pretreatment imaging patterns were: total mismatch 28.9%, substantial mismatch 22.8%, moderate or no mismatch 22.8%, and small perfusion lesion 25.6%. Among total mismatch patients, the Tmax>6 sec perfusion lesion volume was 56.5 ml (IQR 28.3-85.6) and time from last known well to imaging was 89 mins (IQR 65-296). Compared to moderate patients, clinical features of total mismatch patients were: older (76.0 vs 65.9, p=0.006), lower NIHSS (median 12 vs 18, p=0.019), and more cardioembolism (76.9% vs 48.8%, p=0.005). Total mismatch patients more often had CT than MR (65.4% vs 14.6%, p=0.000), less ICA occlusion (15.4% vs 34.1%, p=0.035), and smaller perfusion lesions (median 56.5 vs 82.1 ml, p=0.007). Total mismatch patients were treated with combined IVT+EVT in 32.7%, IVT alone in 26.9%, and EVT alone in 40.4%. Freedom from disability (mRS 0-1) at discharge was more frequent, 35.6% vs 16.2%, p=0.049 and disability levels at day 90 were lower in total mismatch patients, mean mRS 2.7 vs 3.9, p=0.029. Conclusion: Total mismatch is present in one-quarter of patients undergoing reperfusion therapy, more often in older patients with cardioembolism as etiology of stroke. Total mismatch patients have better disability outcomes from reperfusion therapy, but more than half show disability indicating need for more complete reperfusion.

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Cohort profile: Thrombolysis in Ischemic Stroke Patients (TRISP): a multicentre research collaboration

BMJ Open ◽

10.1136/bmjopen-2018-023265 ◽

2018 ◽

Vol 8 (9) ◽

pp. e023265 ◽

Cited By ~ 3

Author(s):

Jan F Scheitz ◽

Henrik Gensicke ◽

Sanne M Zinkstok ◽

Sami Curtze ◽

Marcel Arnold ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Functional Outcome ◽

Research Collaboration ◽

Intravenous Thrombolysis ◽

Stroke Patients ◽

Acute Stroke Care ◽

Laboratory Findings ◽

Endovascular Thrombectomy ◽

Multicentre Research

PurposeThe ThRombolysis in Ischemic Stroke Patients (TRISP) collaboration aims to address clinically relevant questions about safety and outcomes of intravenous thrombolysis (IVT) and endovascular thrombectomy. The findings can provide observational information on treatment of patients derived from everyday clinical practice.ParticipantsTRISP is an open, investigator-driven collaborative research initiative of European stroke centres with expertise in treatment with revascularisation therapies and maintenance of hospital-based registries. All participating centres made a commitment to prospectively collect data on consecutive patients with stroke treated with IVT using standardised definitions of variables and outcomes, to assure accuracy and completeness of the data and to adapt their local databases to answer novel research questions.Findings to dateCurrently, TRISP comprises 18 centres and registers >10 000 IVT-treated patients. Prior TRISP projects provided evidence on the safety and functional outcome in relevant subgroups of patients who were excluded, under-represented or not specifically addressed in randomised controlled trials (ie, pre-existing disability, cervical artery dissections, stroke mimics, prior statin use), demonstrated deficits in organisation of acute stroke care (ie, IVT during non-working hours, effects of onset-to-door time on onset-to-needle time), evaluated the association between laboratory findings on outcome after IVT and served to develop risk estimation tools for prediction of haemorrhagic complications and functional outcome after IVT.Future plansFurther TRISP projects to increase knowledge of the effect and safety of revascularisation therapies in acute stroke are ongoing. TRISP welcomes participation and project proposals of further centres fulfilling the outlined requirements. In the future, TRISP will be extended to include patients undergoing endovascular thrombectomy.

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Swiss guidelines for the prehospital phase in suspected acute stroke

Clinical and Translational Neuroscience ◽

10.1177/2514183x21999230 ◽

2021 ◽

Vol 5 (1) ◽

pp. 2514183X2199923

Author(s):

Georg Kägi ◽

David Schurter ◽

Julien Niederhäuser ◽

Gian Marco De Marchis ◽

Stefan Engelter ◽

...

Keyword(s):

Acute Stroke ◽

Arterial Occlusion ◽

Intravenous Thrombolysis ◽

Current Guideline ◽

Stroke Patients ◽

Stroke Units ◽

Stroke Treatment ◽

Prehospital Phase ◽

Acute Stroke Treatment ◽

The Right

Acute stroke treatment has advanced substantially over the last years. Important milestones constitute intravenous thrombolysis, endovascular therapy (EVT), and treatment of stroke patients in dedicated units (stroke units). At present in Switzerland there are 13 certified stroke units and 10 certified EVT-capable stroke centers. Emerging challenges for the prehospital pathways are that (i) acute stroke treatment remains very time sensitive, (ii) the time window for acute stroke treatment has opened up to 24 h in selected cases, and (iii) EVT is only available in stroke centers. The goal of the current guideline is to standardize the prehospital phase of patients with acute stroke for them to receive the optimal treatment without unnecessary delays. Different prehospital models exist. For patients with large vessel occlusion (LVO), the Drip and Ship model is the most commonly used in Switzerland. This model is challenged by the Mothership model where stroke patients with suspected LVO are directly transferred to the stroke center. This latter model is only effective if there is an accurate triage by paramedics, hence the patient may benefit from the right treatment in the right place, without loss of time. Although the Cincinnati Prehospital Stroke Scale is a well-established scale to detect acute stroke in the prehospital setting, it neglects nonmotor symptoms like visual impairment or severe vertigo. Therefore we suggest “acute occurrence of a focal neurological deficit” as the trigger to enter the acute stroke pathway. For the triage whether a patient has a LVO (yes/no), there are a number of scores published. Accuracy of these scores is borderline. Nevertheless, applying the Rapid Arterial Occlusion Evaluation score or a comparable score to recognize patients with LVO may help to speed up and triage prehospital pathways. Ultimately, the decision of which model to use in which stroke network will depend on local (e.g. geographical) characteristics.

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Abstract W P8: "Double Trouble": Endovascular Treatment of Tandem Arterial Occlusions in Acute Ischemic Stroke

Stroke ◽

10.1161/str.46.suppl_1.wp8 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Mikayel Grigoryan ◽

Diogo Haussen ◽

Andrey Lima ◽

Jonathan Grossberg ◽

Shannon Doppelheuer ◽

...

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Clinical Outcomes ◽

Arterial Occlusion ◽

Intravenous Thrombolysis ◽

Imaging Data ◽

Stroke Patients ◽

Symptomatic Intracerebral Hemorrhage

Background: Tandem extracranial/intracranial arterial occlusions in acute stroke present treatment challenges both due to suboptimal response to systemic intravenous thrombolysis as well as complex endovascular approach. We report our experience in treating this cohort of acute stroke patients with the analysis of angiographic and clinical outcomes Materials and Methods: We retrospectively reviewed clinical and imaging data of all consecutive acute stroke patients with proximal intracranial arterial occlusion and additional extracranial occlusion/critical stenosis, treated with endovascular techniques between February 2011 and February 2014 at two hospitals. We analyzed patients’ demographics, clinical presentation, treatment strategies, time to recanalization, imaging and clinical outcomes. Results: A total of 66 patients were included. The mean NIHSS on presentation was 19. Extracranial carotid with concomitant intracranial anterior circulation occlusions were present in 95% of the patients (63/66), while 5% (3/66) had tandem vertebrobasilar occlusions. 41% of the patients (27/66) received intravenous rt-PA. With regards to endovascular treatment, in 70% of the cases (46/66), extracranial lesion was treated with a stent placement. Stentrievers were used in 50% (33/66) of the patients for intracranial thrombectomy. Thrombolysis in Cerebral Infarction (TICI) >= 2B reperfusion was achieved in 77% of all the patients (51/66) and in 97% (32/33) of the stentriever patients. Good clinical outcome at 90 days (mRS<=2) was seen in 42% of the patients. Symptomatic intracerebral hemorrhage (PH-2)occurred in 9% (6/66) of the patients. Conclusions: Endovascular treatment of tandem arterial occlusions in acute ischemic stroke is relatively safe, feasible, and may yield excellent angiographic and good clinical outcomes.

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TAB-TICI Score: Successful Recanalization Score After Endovascular Thrombectomy in Acute Stroke

Frontiers in Neurology ◽

10.3389/fneur.2021.692490 ◽

2021 ◽

Vol 12 ◽

Author(s):

Woo-Keun Seo ◽

Hyo Suk Nam ◽

Jong-Won Chung ◽

Young Dae Kim ◽

Keon-Ha Kim ◽

...

Keyword(s):

Acute Stroke ◽

External Validation ◽

Reperfusion Therapy ◽

Sensitivity Analyses ◽

Stroke Patients ◽

Training Population ◽

Vessel Occlusion ◽

Endovascular Thrombectomy ◽

Stroke Registry ◽

Validation Population

Background and Purpose: Successful reperfusion therapy is supposed to be comprehensive and validated beyond the grade of recanalization. This study aimed to develop a novel scoring system for defining the successful recanalization after endovascular thrombectomy.Methods: We analyzed the data of consecutive acute stroke patients who were eligible to undergo reperfusion therapy within 24 h of onset and who underwent mechanical thrombectomy using a nationwide multicenter stroke registry. A new score was produced using the predictors which were directly linked to the procedure to evaluate the performance of the thrombectomy procedure.Results: In total, 446 patients in the training population and 222 patients in the validation population were analyzed. From the potential components of the score, four items were selected: Emergency Room-to-puncture time (T), adjuvant devices used (A), procedural intracranial bleeding (B), and post-thrombectomy reperfusion status [Thrombolysis in Cerebral Infarction (TICI)]. Using these items, the TAB-TICI score was developed, which showed good performance in terms of discriminating early neurological aggravation [AUC 0.73, 95% confidence interval (CI) 0.67–0.78, P < 0.01] and favorable outcomes (AUC 0.69, 95% CI 0.64–0.75, P < 0.01) in the training population. The stability of the TAB-TICI score was confirmed by external validation and sensitivity analyses. The TAB-TICI score and its derived grade of successful recanalization were significantly associated with the volume of thrombectomy cases at each site and in each admission year.Conclusion: The TAB-TICI score is a valid and easy-to-use tool to more comprehensively define successful recanalization after endovascular thrombectomy in acute stroke patients with large vessel occlusion.

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Abstract WP140: Imaging of Clot Porosity Prior to Endovascular Thrombectomy

Stroke ◽

10.1161/str.48.suppl_1.wp140 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

David S Liebeskind ◽

Elijah Agbayani ◽

Graham W Woolf ◽

Baixue Jia ◽

Nerses Sanossian ◽

...

Keyword(s):

Single Phase ◽

Endovascular Procedures ◽

Arterial Occlusion ◽

Intravenous Thrombolysis ◽

Artery Occlusion ◽

Large Artery ◽

Surface Mapping ◽

Endovascular Thrombectomy ◽

Luminal Narrowing ◽

Close Proximity

Background: Clot characteristics and porosity at the proximal portion of an arterial occlusion may influence potential recanalization. Thrombus permeability may be a factor in intravenous thrombolysis, whereas such features of clots prior to endovascular thrombectomy remains largely unexplored. We developed a technique to image clot porosity and yield quantitative measures that may predict mechanical recanalization. Methods: Consecutive cases of large artery occlusion (ICA or proximal M1 MCA) with single-phase CT angiography (CTA) acquired immediately prior to endovascular thrombectomy were analyzed. 3D-reconstruction, vessel segmentation, centerline extraction, signal intensity gradient calculations and surface mapping of CTA yielded porosity images and quantitative measures. Porosity measures were correlated with angiography parameters and procedural details. Results: 53 consecutive cases of acute stroke with contemporaneous sCTA and DSA were used to generate porosity images. Technical limitations precluded image processing in 9 cases, due to diminished contrast conspicuity in close proximity to bone interfaces. Porosity features on resulting images and the quantitative measures of clot penetration varied markedly, even within the subset of M1 or ICA occlusions, respectively. The occlusions often exhibited long segments (mean 18 ± 11 mm) of luminal narrowing before complete occlusion. Current analyses examine whether higher porosity or greater proximal contrast penetration of the clot is associated with faster recanalization and fewer device passes during endovascular thrombectomy. Conclusions: Clot porosity images and quantitative measures of proximal contrast penetration may be generated from routine CTA. Imaging of clot porosity may be a useful adjunct in planning of endovascular procedures and future strategies may focus on distinguishing atherosclerotic versus thromboembolic large artery occlusions.

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