Abstract Details

Title Characterizing Clot Composition and Stroke Etiology Through Hounsfield Unit Analysis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P10 - Poster Session 10 (8:00 AM-9:00 AM)

Poster/Presentation
Number 5-021

Objective Analyze clot composition using Hounsfield units (HU) in non-enhanced computed tomography (NECT).

Background Clot composition might offer insights about ischemic stroke mechanism. Hounsfield units (HU) characterizes tissues densities in non-enhanced computed tomography (NECT).

Design/Methods A first phase involved a prospective cohort analyzing HU with histological composition of thrombus retrieved following mechanical thrombectomy (MT). The thrombi were imaged on micro-computed tomography (micro-CT) and subsequently analyzed histologically. Micro-CT slides were matched to histological sections. Regions composed of red blood cells (RBCs) and fibrin were isolated, and corresponding HU values were retrieved. Spearman’s rank correlation was performed to correlate micro-CT HU with percentage composition. The same clots were localized in the pre-MT NECT and NECT HU were obtained. Micro-CT HU and NECT HU were correlated to enable histologically-informed interpretation. Receiver operating characteristic analysis was performed to assess the accuracy of NECT HU in analyzing clot composition. In a second phase, a retrospective large dataset of NECT images of patients with different stroke etiologies were assessed using NECT HU.

Results Ten clots were analyzed. Micro-CT HU were correlated with histological sections with >70% of RBCs (Rho 0.675) and with NECT HU of clots that had > 70% of RBCs (Rho 0.774). NECT HU of 44 had a sensitivity of 100% and specificity of 86% to determine clots with > 70% of RBCs composition in NECT. Consequently, 150 NECT images were analyzed including 50 cardioembolic, 50 large artery atherosclerosis (LAA) and 50 cryptogenic strokes. HU assessment showed that 74% cardioembolic, 32% LAA and 48% of cryptogenic clots had RBCs as main component.

Conclusions NECT HU is promising to assess clot composition in NECT.

Authors/Disclosures
Alexander J. Van Dam PRESENTER	Mr. Van Dam has nothing to disclose.
Andres Gudino (University of Iowa Hospitals and Clinics)	Mr. Gudino has nothing to disclose.
Carlos Dier	No disclosure on file
Martin A. Cabarique, MD	Dr. Cabarique has nothing to disclose.
Elena Sagues, MD (University of Iowa Hospitals and Clinics)	Ms. Sagues has nothing to disclose.
Arshaq Saleem	The institution of Mr. Saleem has received research support from National Institutes of Health.
Navami Shenoy	Ms. Shenoy has nothing to disclose.
Malik Ghannam, MBBCh	Dr. Ghannam has nothing to disclose.
Edgar Samaniego, MD, FAAN (University of Iowa Hospital and Clinics)	Dr. Samaniego has received personal compensation for serving as an employee of University of Iowa. Dr. Samaniego has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Terumo Neuro. Dr. Samaniego has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Rapid Medical. Dr. Samaniego has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for J&J Neuro. Dr. Samaniego has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Metronic. Dr. Samaniego has received personal compensation in the range of $0-$499 for serving as a Consultant for iSchemaView. Dr. Samaniego has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Society of Neurointerventional Surgery. Dr. Samaniego has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Neurointerventional Surgery.

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