{
  "abstract": "Background A relevant proportion of patients experience early neurological deterioration (END) despite technically successful recanalisation for acute ischaemic stroke. We prospectively assessed the distal occlusion tracker (DOT) sign, detectable on flat-panel detector CT (FPDCT) immediately after mechanical thrombectomy (MT), to identify distal embolisation or incomplete microvascular reperfusion associated with END.Methods Our prospective multicentre observational study included consecutive patients with anterior circulation stroke treated with MT between January 2022 and December 2023 at two large comprehensive stroke centres. Post-procedural FPDCT was used to assess the presence of the DOT sign. The primary outcome was END. Secondary outcomes included 3 month functional outcome, 24 hour Alberta Stroke Program Early CT Score (ASPECTS) and haemorrhagic complications. Associations between the DOT sign and clinical-radiological variables, including Thrombolysis in Cerebral Infarction recanalization score (TICI), were evaluated through univariate and multivariate logistic regression.Results The DOT sign was present in 31% of cases and was associated with higher rates of END (25% vs 12.8%, p=0.003), lower recanalisation success (79.3% vs 91.1%, p<0.001) and greater prevalence of cortical hyperattenuation. On multivariate analysis, independent predictors of END included the DOT sign (aOR=2.07, p=0.040), cardioembolic aetiology, baseline National Institutes of Health Stroke Scale, FPDCT ASPECTS and unsuccessful reperfusion. The DOT sign led to reclassification of half of TICI 3 cases to lower grades. No significant difference in symptomatic intracranial haemorrhage was observed between groups.Conclusions The DOT sign is a practical post-thrombectomy imaging marker helping in the prediction of END. Integrating the DOT sign assessment may help in the stratification of tissues at risk and risk of END, adding to the selection of patients for adjunctive intra-arterial medications.",
  "authors": [
    {
      "affiliations": [
        "Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy",
        "Department of Neurosciences, Neurology and Stroke Unit, Bufalini Hospital, AUSL Romagna, Cesena, Italy"
      ],
      "name": "Valentina Tudisco"
    },
    {
      "affiliations": [
        "Department of Neurosciences, Neurology and Stroke Unit, Bufalini Hospital, AUSL Romagna, Cesena, Italy"
      ],
      "name": "Michele Romoli"
    },
    {
      "affiliations": [
        "Department of Neurosciences, Neurology and Stroke Unit, Bufalini Hospital, AUSL Romagna, Cesena, Italy"
      ],
      "name": "Francesca Giannini"
    },
    {
      "affiliations": [
        "Department of Neurosciences, Neurology and Stroke Unit, Bufalini Hospital, AUSL Romagna, Cesena, Italy"
      ],
      "name": "Beatrice Severi"
    },
    {
      "affiliations": [
        "Department of Neurosciences, Neurology and Stroke Unit, Bufalini Hospital, AUSL Romagna, Cesena, Italy"
      ],
      "name": "Alessandro Polimene"
    },
    {
      "affiliations": [
        "Department of Neurosciences, Neurology and Stroke Unit, Bufalini Hospital, AUSL Romagna, Cesena, Italy"
      ],
      "name": "Francesca Biondi"
    },
    {
      "affiliations": [
        "Neuroradiology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Sicily, Italy"
      ],
      "name": "Davide Vicari"
    },
    {
      "affiliations": [
        "Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy"
      ],
      "name": "Ludovica Ferraù"
    },
    {
      "affiliations": [
        "Department of Neurosciences, Neurology and Stroke Unit, Bufalini Hospital, AUSL Romagna, Cesena, Italy"
      ],
      "name": "Francesco Cordici"
    },
    {
      "affiliations": [
        "Department of Neurosciences, Neurology and Stroke Unit, Bufalini Hospital, AUSL Romagna, Cesena, Italy"
      ],
      "name": "Federica N Sepe"
    },
    {
      "affiliations": [
        "Department of Neurosciences, Neurology and Stroke Unit, Bufalini Hospital, AUSL Romagna, Cesena, Italy"
      ],
      "name": "Sebastiano Giacomozzi"
    },
    {
      "affiliations": [
        "Department of Neurosciences, Neurology and Stroke Unit, Bufalini Hospital, AUSL Romagna, Cesena, Italy"
      ],
      "name": "Giuseppe Borzì"
    },
    {
      "affiliations": [
        "Department of Clinical and Experimental Medicine, University of Messina, Messina, Sicily, Italy"
      ],
      "name": "Cristina Dell’Aera"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Department of Neurosciences, Bufalini Hospital, AUSL Romagna, Cesena, Italy"
      ],
      "name": "Alberto Di Ruzza"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Department of Neurosciences, Bufalini Hospital, AUSL Romagna, Cesena, Italy"
      ],
      "name": "Elvis Lafe"
    },
    {
      "affiliations": [
        "Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy",
        "Department of Biomedical, Dental Science and Morphological and Functional Images, Neuchatel Hospital Campus La Chaux-de-Fonds, La Chaux-de-Fonds, Switzerland"
      ],
      "name": "Fabrizio Giammello"
    },
    {
      "affiliations": [
        "Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy"
      ],
      "name": "Antonio Toscano"
    },
    {
      "affiliations": [
        "Department of Neurosciences, Neurology and Stroke Unit, Bufalini Hospital, AUSL Romagna, Cesena, Italy"
      ],
      "name": "Marco Longoni"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Department of Neurosciences, Bufalini Hospital, AUSL Romagna, Cesena, Italy"
      ],
      "name": "Maria Ruggiero"
    }
  ],
  "title": "Impact of flat-panel detector CT distal occlusion tracker (DOT) sign on early neurological deterioration after endovascular thrombectomy",
  "uid": "5cc54ea7-71e7-5a56-8d51-a2a1371a2f92"
}