Title:Effect on Successful Recanalization of Thrombus Length in Susceptibility- weighted Imaging in Mechanical Thrombectomy with Stentretrieval
Volume: 18
Issue: 1
Author(s): Dong Hoon Lee, Jae Hoon Sung*, Ho Jun Yi, Min Hyung Lee and Seung Yoon Song
Affiliation:
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Seoul,Korea
Keywords:
Mechanical thrombectomy, thrombus length, susceptibility-weighted imaging, failed recanalization, 3 stent-retriever
passages, maximum intensity projection.
Abstract:
Introduction: Susceptibility-Eeighted Imaging (SWI) enables visualization of thrombotic
material in acute ischemic stroke. We analyzed the association between thrombus length on SWI
and the success rate of recanalization in stent-retriever mechanical thrombectomy.
Methods: A retrospective study was performed on 128 patients with Middle Cerebral Artery (MCA)
thrombus on pretreatment SWI. The patients were divided into 2 groups, the successful recanalization
and the failed recanalization group. Thrombus visibility and location on SWI were compared
to those on Maximum Intensity Projection (MIP) in Computed Tomography (CT) angiography.
A comparative analysis was performed in terms of clinical and radiologic outcomes as well as
complications with respect to multiple categories.
Results: No significant differences were noted in terms of baseline characteristics and clinical outcomes
between the 2 groups. However, compared with the successful recanalization group, the
failed recanalization group had a larger number of stent-retriever passages and a longer thrombus
length (p = 0.027 and 0.014, respectively). Multivariate analyses revealed that a larger mean number
of stent-retriever passages was a predictive factor for failure of recanalization (odds ratio [OR]
1.60; 95% confidence Interval [CI] 1.12-2.08; p = 0.04). Thrombus length (OR 9.91; 95% CI
3.89-13.87; p < 0.001) and atrial fibrillation (OR 5.38; 95% CI 1.51-9.58; p = 0.008) were separately
associated with more than 3 stent-retriever passages.
Conclusion: Thrombus length has been identified as a predictor of recanalization failure in mechanical
thrombectomy. A significant decline in the success rate of recanalization was associated with
longer thrombus length.
