{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T02:07:06Z","timestamp":1788228426536,"version":"build-2803163510"},"reference-count":26,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,1,25]],"date-time":"2023-01-25T00:00:00Z","timestamp":1674604800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Purpose: Thrombus permeability has been related to clot composition and treatment outcomes in stroke patients undergoing reperfusion therapies. The aim of this study was to evaluate whether thrombus perviousness, evaluated by multiphase computed tomography angiography (mCTA), is associated with distal embolization risk. Methods: We interrogated our dataset of acute ischemic stroke (AIS) patients involving the M1 segment of the middle cerebral artery (MCA) who had undergone mechanical thrombectomy, and we calculated thrombus average attenuation measurement (dHU) on non-contrast CT (NCCT) and clot perviousness on mCTA. dHU was calculated as the difference between the thrombus HU average value (tHU) and the HU average value on the contralateral side (cHU), while perviousness was calculated as the difference in mean clot density on mCTA and NCCT both in arterial (Perviousness pre-post-1) and delayed (Perviousness pre-post 2) phases. Results: A total of 100 patients (53 females (53%), mean age 72.74 [\u00b1 2.31]) with M1 occlusion were available for analysis. Perviousness, calculated between baseline and arterial phase of mCTA (Perviousness pre-post1), was lower in patients with distal embolization (p = 0.05), revealing an association between reduced perviousness and distal embolization risk. Logistic regression showed that thrombus perviousness calculated on the arterial phase of mCTA (OR, 0.66; 95% CI, 0.44\u20130.99] (p = 0.04)) and the contact aspiration technique (OR, 0.39; 95% CI, 0.15\u20131.02] (p = 0.05)) were protecting factors against distal embolization. Conclusion: Our study showed an association between reduced perviousness and distal embolization, suggesting that perviousness evaluation may be a useful neuroimaging biomarker in predicting distal embolization risk during mechanical thrombectomy.<\/jats:p>","DOI":"10.3390\/diagnostics13030431","type":"journal-article","created":{"date-parts":[[2023,1,26]],"date-time":"2023-01-26T01:57:07Z","timestamp":1674698227000},"page":"431","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Correlation between Thrombus Perviousness and Distal Embolization during Mechanical Thrombectomy in Acute Stroke"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7248-3916","authenticated-orcid":false,"given":"Fabio","family":"Pilato","sequence":"first","affiliation":[{"name":"Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Universit\u00e0 Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy"},{"name":"Operative Research Unit of Neurology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iacopo","family":"Valente","sequence":"additional","affiliation":[{"name":"UOC Radiologia e Neuroradiologia, Polo Diagnostica Per Immagini, Radioterapia, Oncologia ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma\u2014Area Diagnostica Per Immagini, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8080-3916","authenticated-orcid":false,"given":"Andrea M.","family":"Alexandre","sequence":"additional","affiliation":[{"name":"UOC Radiologia e Neuroradiologia, Polo Diagnostica Per Immagini, Radioterapia, Oncologia ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma\u2014Area Diagnostica Per Immagini, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4517-3477","authenticated-orcid":false,"given":"Rosalinda","family":"Calandrelli","sequence":"additional","affiliation":[{"name":"UOC Radiologia e Neuroradiologia, Polo Diagnostica Per Immagini, Radioterapia, Oncologia ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma\u2014Area Diagnostica Per Immagini, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1316-0383","authenticated-orcid":false,"given":"Luca","family":"Scarcia","sequence":"additional","affiliation":[{"name":"UOC Radiologia e Neuroradiologia, Polo Diagnostica Per Immagini, Radioterapia, Oncologia ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma\u2014Area Diagnostica Per Immagini, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"D\u2019Argento","sequence":"additional","affiliation":[{"name":"UOC Radiologia e Neuroradiologia, Polo Diagnostica Per Immagini, Radioterapia, Oncologia ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma\u2014Area Diagnostica Per Immagini, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3992-9071","authenticated-orcid":false,"given":"Emilio","family":"Lozupone","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Vito Fazzi Hospital, 73100 Lecce, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Arena","sequence":"additional","affiliation":[{"name":"Istituto di Anatomia Patologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanit\u00e0 Pubblica-Area Anatomia Patologica-Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2558-8838","authenticated-orcid":false,"given":"Alessandro","family":"Pedicelli","sequence":"additional","affiliation":[{"name":"UOC Radiologia e Neuroradiologia, Polo Diagnostica Per Immagini, Radioterapia, Oncologia ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma\u2014Area Diagnostica Per Immagini, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3777","DOI":"10.1161\/STROKEAHA.109.561431","article-title":"Predictors of Good Clinical Outcomes, Mortality, and Successful Revascularization in Patients with Acute Ischemic Stroke Undergoing Thrombectomy","volume":"40","author":"Nogueira","year":"2009","journal-title":"Stroke"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e56","DOI":"10.1161\/CIR.0000000000000659","article-title":"Heart disease and stroke statistics\u20142019 update: A report from the American heart association","volume":"139","author":"Benjamin","year":"2019","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Pilato, F., Silva, S., Valente, I., Distefano, M., Broccolini, A., Brunetti, V., Caliandro, P., Della Marca, G., Di Iorio, R., and Frisullo, G. (2020). Predicting Factors of Functional Outcome in Patients with Acute Ischemic Stroke Admitted to Neuro-Intensive Care Unit. A Prospective Cohort Study. Brain Sci., 10.","DOI":"10.3390\/brainsci10120911"},{"key":"ref_4","first-page":"20","article-title":"Identifying the predictors of first-pass effect and its influence on clinical outcome in the setting of endovascular thrombectomy for acute ischemic stroke: Results from a multicentric prospective registry","volume":"16","author":"Kyheng","year":"2020","journal-title":"Int. J. Stroke"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1161\/STROKEAHA.115.011187","article-title":"Thrombus Permeability Is Associated with Improved Functional Outcome and Recanalization in Patients with Ischemic Stroke","volume":"47","author":"Santos","year":"2016","journal-title":"Stroke"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"120087","DOI":"10.1016\/j.jns.2021.120087","article-title":"Clot evaluation and distal embolization risk during mechanical thrombectomy in anterior circulation stroke","volume":"432","author":"Pilato","year":"2021","journal-title":"J. Neurol. Sci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1136\/neurintsurg-2021-018447","article-title":"Thrombus enhancement sign on CT angiography is associated with the first pass effect of stent retrievers","volume":"15","author":"He","year":"2022","journal-title":"J. NeuroInterventional Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"119989","DOI":"10.1016\/j.jns.2021.119989","article-title":"Color-coded multiphase computed tomography angiography may predict outcome in anterior circulation acute ischemic stroke","volume":"430","author":"Pilato","year":"2021","journal-title":"J. Neurol. Sci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2674","DOI":"10.1161\/STROKEAHA.118.021873","article-title":"Thrombus Permeability in Admission Computed Tomographic Imaging Indicates Stroke Pathogenesis Based on Thrombus Histology","volume":"49","author":"Berndt","year":"2018","journal-title":"Stroke"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1136\/neurintsurg-2019-014979","article-title":"Clot permeability and histopathology: Is a clot\u2019s perviousness on CT imaging correlated with its histologic composition?","volume":"12","author":"Benson","year":"2019","journal-title":"J. NeuroInterventional Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"57","DOI":"10.3174\/ajnr.A6866","article-title":"Increased Perviousness on CT for Acute Ischemic Stroke is Associated with Fibrin\/Platelet-Rich Clots","volume":"42","author":"Patel","year":"2020","journal-title":"Am. J. Neuroradiol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Verdolotti, T., Pilato, F., Cottonaro, S., Monelli, E., Giordano, C., Guadalupi, P., Benenati, M., Ramaglia, A., Costantini, A.M., and Alexandre, A. (2020). ColorViz, a New and Rapid Tool for Assessing Collateral Circulation during Stroke. Brain Sci., 10.","DOI":"10.3390\/brainsci10110882"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e1686","DOI":"10.1212\/WNL.0000000000008395","article-title":"Acute ischemic stroke thrombi have an outer shell that impairs fibrinolysis","volume":"93","author":"Desilles","year":"2019","journal-title":"Neurology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1161\/STROKEAHA.120.032810","article-title":"Thrombus Composition and Efficacy of Thrombolysis and Thrombectomy in Acute Ischemic Stroke","volume":"52","author":"Jolugbo","year":"2021","journal-title":"Stroke"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1808","DOI":"10.1182\/blood-2014-01-550335","article-title":"A systems approach to hemostasis: 1. The interdependence of thrombus architecture and agonist movements in the gaps between platelets","volume":"124","author":"Welsh","year":"2014","journal-title":"Blood"},{"key":"ref_16","first-page":"189","article-title":"The Impact of Histological Clot Composition in Embolic Stroke","volume":"26","author":"Schubert","year":"2014","journal-title":"Clin. Neuroradiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1136\/neurintsurg-2016-012591","article-title":"Impact of thrombus length on recanalization and clinical outcome following mechanical thrombectomy in acute ischemic stroke","volume":"9","author":"Seker","year":"2016","journal-title":"J. NeuroInterventional Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1007\/s00062-020-00957-4","article-title":"Introduction of CTA-index as Simplified Measuring Method for Thrombus Perviousness","volume":"31","author":"Berndt","year":"2020","journal-title":"Clin. Neuroradiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2058","DOI":"10.1161\/STROKEAHA.116.013306","article-title":"Permeable Thrombi Are Associated with Higher Intravenous Recombinant Tissue-Type Plasminogen Activator Treatment Success in Patients with Acute Ischemic Stroke","volume":"47","author":"Santos","year":"2016","journal-title":"Stroke"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1177\/1591019918825444","article-title":"Thrombus perviousness is not associated with first-pass revascularization using stent retrievers","volume":"25","author":"Byun","year":"2019","journal-title":"Interv. Neuroradiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e344","DOI":"10.1161\/STR.0000000000000211","article-title":"Guidelines for the Early Management of Patients with Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals from the American Heart Association\/American Stroke Association","volume":"50","author":"Powers","year":"2019","journal-title":"Stroke"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2534","DOI":"10.1001\/archinte.163.20.2534-a","article-title":"Red vs White Thrombi: Treating the Right Clot Is Crucial","volume":"163","author":"Tan","year":"2003","journal-title":"Arch. Intern. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"106207","DOI":"10.1016\/j.clineuro.2020.106207","article-title":"May endovascular thrombectomy without CT perfusion improve clinical outcome?","volume":"198","author":"Alexandre","year":"2020","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Niesten, J.M., Van Der Schaaf, I.C., Van Dam, L., Vink, A., Vos, J.A., Schonewille, W.J., De Bruin, P.C., Mali, W.P.T.M., and Velthuis, B.K. (2014). Histopathologic Composition of Cerebral Thrombi of Acute Stroke Patients Is Correlated with Stroke Subtype and Thrombus Attenuation. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0088882"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1148\/radiol.2273020530","article-title":"Differentiation of White, Mixed, and Red Thrombi: Value of CT in Estimation of the Prognosis of Thrombolysis\u2014Phantom Study","volume":"228","author":"Kirchhof","year":"2003","journal-title":"Radiology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"104541","DOI":"10.1016\/j.jstrokecerebrovasdis.2019.104541","article-title":"The Effect of Clot Volume and Permeability on Response to Intravenous Tissue Plasminogen Activator in Acute Ischemic Stroke","volume":"29","author":"Bilgic","year":"2020","journal-title":"J. Stroke Cerebrovasc. Dis."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/3\/431\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:15:29Z","timestamp":1760120129000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/3\/431"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,25]]},"references-count":26,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["diagnostics13030431"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13030431","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,25]]}}}