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Updated: May 5, 2026
A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
Published on: August 18, 2015
DOT sign indicates persistent hypoperfusion and poor outcome in patients with incomplete reperfusion following
Adnan Mujanovic1,2, Daniel Windecker1, Bettina Serrallach1
1Department of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, Bern, Switzerland.
Insights
The Distal Occlusion Tracker (DOT) sign on CT scans after stroke treatment indicates a higher risk of persistent hypoperfusion. Identifying this sign may help select patients who could benefit from further reperfusion attempts.
Area of Science:
- Neurology
- Radiology
- Interventional Neuroradiology
Background:
- Incomplete reperfusion after stroke treatment (
- The Distal Occlusion Tracker (DOT) sign is a potential indicator of residual occlusion on post-interventional CT scans.
Purpose of the Study:
- To evaluate the association between the DOT sign on immediate post-interventional flat-panel detector computed tomography (FPDCT) and persistent hypoperfusion.
- To determine if the DOT sign predicts poor patient outcomes after endovascular therapy for stroke.
Main Methods:
- Retrospective analysis of 292 patients undergoing endovascular therapy with available FPDCT and 24-hour perfusion imaging.
- The DOT sign was defined as hyperdense signal on FPDCT indicating residual occlusion.
- Logistic regression was used to assess the association between the DOT sign, persistent hypoperfusion, and poor outcome (modified Rankin Scale score 3-6).
Main Results:
- Among 209 patients with incomplete reperfusion, 61% had a DOT sign and 46% experienced persistent hypoperfusion.
- A present DOT sign was significantly associated with persistent hypoperfusion (aOR 4.8) and poor outcome (aOR 2.6).
- These associations held true across different expanded Thrombolysis in Cerebral Infarction (eTICI) strata.
Conclusions:
- The DOT sign on immediate post-interventional FPDCT is a reliable predictor of persistent hypoperfusion after stroke treatment.
- Patients with incomplete reperfusion and a DOT sign represent a subgroup that may benefit from additional reperfusion strategies.
- The DOT sign aids in identifying patients at higher risk for poor outcomes, guiding further treatment decisions.
Background:
Distal occlusions associated with incomplete reperfusion (expanded Thrombolysis in Cerebral Infarction,
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
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