{
  "abstract": "Background Distal occlusions associated with incomplete reperfusion (expanded Thrombolysis in Cerebral Infarction, <eTICI 3) may not reperfuse spontaneously and thus prompt ischemia (ie, persistent hypoperfusion). We aimed to assess whether the recently reported Distal Occlusion Tracker (DOT) sign on immediate non-contrast post-interventional flat-panel detector computed tomography (FPDCT) is associated with persistent hypoperfusion.Methods Retrospective registry analysis of patients undergoing endovascular therapy between July 2020 and December 2022, with available immediate post-interventional FPDCT and 24 hours follow-up perfusion imaging. Persistent hypoperfusion was defined as a perfusion deficit at 24 hours directly corresponding to the area of incomplete reperfusion on final angiography run. The DOT sign was defined as a punctiform or tubular hyperdense signal increase on FPDCT indicative of a residual occlusion. Association between the DOT sign (present/absent) with the occurrence of persistent hypoperfusion and poor outcome (modified Rankin scale (mRS) score 3–6) was evaluated using logistic regression analysis.Results Of 292 patients included (median age 73 years; 47% female), 209 had incomplete reperfusion. Among patients with incomplete reperfusion, 61% had a present DOT sign and 46% had persistent hypoperfusion. In the overall cohort, but also within each eTICI stratum, a present DOT sign was associated with persistent hypoperfusion on 24±12 hours follow-up perfusion imaging (adjusted odds ratio (aOR) 4.8, 95% confidence interval (CI) 2.0 to 12.3 for patients with eTICI 2 a-2c). A present DOT sign was also associated with poor outcome (aOR 2.6, 95% CI 1.1 to 6.2).Conclusion Patients with <eTICI 3 and a present DOT sign have a higher likelihood of persistent hypoperfusion and might constitute a subgroup that could particularly benefit from additional reperfusion attempts.",
  "authors": [
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, Bern, Switzerland",
        "Graduate School for Health Sciences, University of Bern, Bern, Switzerland"
      ],
      "name": "Adnan Mujanovic"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, Bern, Switzerland"
      ],
      "name": "Daniel Windecker"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, Bern, Switzerland"
      ],
      "name": "Bettina Serrallach"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, Bern, Switzerland",
        "Graduate School for Health Sciences, University of Bern, Bern, Switzerland",
        "Department of Diagnostic, Interventional and Pediatric Radiology, University Hospital Bern Inselspital, Bern, Switzerland"
      ],
      "name": "Christoph C Kurmann"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, Bern, Switzerland",
        "Graduate School for Health Sciences, University of Bern, Bern, Switzerland"
      ],
      "name": "Roman Rohner"
    },
    {
      "affiliations": [
        "Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland"
      ],
      "name": "Elias Auer"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, Bern, Switzerland",
        "Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany",
        "Department of Medical Imaging, St. Anne’s University Hospital Brno, Brno, Czech Republic"
      ],
      "name": "Petra Cimflova"
    },
    {
      "affiliations": [
        "Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland"
      ],
      "name": "Thomas R Meinel"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, University Hospital Bonn, Bonn, Germany"
      ],
      "name": "Franziska Dorn"
    },
    {
      "affiliations": [
        "Department of Neuroradiology and Endovascular Therapy, Alfried Krupp Krankenhaus Ruttenscheid, Essen, Germany"
      ],
      "name": "René Chapot"
    },
    {
      "affiliations": [
        "Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland"
      ],
      "name": "David Seiffge"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, Bern, Switzerland"
      ],
      "name": "Eike Immo I Piechowiak"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, Bern, Switzerland"
      ],
      "name": "Tomas Dobrocky"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, Bern, Switzerland"
      ],
      "name": "Jan Gralla"
    },
    {
      "affiliations": [
        "Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland"
      ],
      "name": "Urs Fischer"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, Bern, Switzerland"
      ],
      "name": "Sara Pilgram-Pastor"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, Bern, Switzerland",
        "Diagnostic and Interventional Neuroradiology, CIC-IT 1415, CHRU de Tours, Tours, France",
        "Le Studium Loire Valley Institute for Advanced Studies, Orléans, France"
      ],
      "name": "Johannes Kaesmacher"
    }
  ],
  "title": "DOT sign indicates persistent hypoperfusion and poor outcome in patients with incomplete reperfusion following thrombectomy",
  "uid": "35afb0f1-06bf-570b-98a5-c6da13917464"
}