Objectives Post-contrast magnetic resonance angiography (PC-MRA) enables visualization of vessel segments distal to an intra-arterial thrombus in acute ischemic stroke. We hypothesized that PC-MRA also allows clot length measurement in different intracranial vessels.
Methods Patients with MRI-confirmed ischemic stroke and intracranial artery occlusion within 24 hours of symptom onset were prospectively evaluated. PC-MRA was added to a standard stroke MRI protocol. Thrombus length was measured on thick slab maximum intensity projection images. Clinical outcome at hospital discharge was assessed by modified Rankin Scale (mRS).
Results Thirty-four patients (median age 72 years) presenting with a median National Institutes of Health Stroke Scale score of 11 and a median onset to imaging time of 116 min were included. PC-MRA enabled precise depiction of proximal and distal terminus of the thrombus in 31 patients (91%), whereas in three patients (9%) PC-MRA presented a partial occlusion. Median thrombus length in patients with complete occlusion was 9.9 mm. In patients with poor outcome (mRS ≥3) median thrombus length was significantly longer than in those with good outcome (mRS ≤2;P=0.011).
Conclusions PC-MRA demonstrates intra-arterial thrombus length at different vessel occlusion sites. Longer thrombus length is associated with poor clinical outcome.
Clinical trial registration NCT02077582; Results.
- magnetic resonance angiography
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Contributors RG and JBF substantially contributed to the conception of the work, the acquisition, analysis and interpretation of the data for the work. All authors played a role in drafting the article or revising it critically for important intellectual content, and all authors were involved in final approval of the version to be published.
Funding This work was supported by the Federal Ministry of Education and Research via the grant Center for Stroke Research (01EO01301).
Competing interests JBF has received consulting, lecture and advisory board fees from Perceptive, BioClinica, Boehringer Ingelheim, Brainomix, Lundbeck and Sygnis. KH reports study grants by Bayer Healthcare, a study grant by Sanofi-Aventis, lecture fees from Bayer Healthcare, Sanofi-Aventis, Pfizer and Bristol-Myers Squibb as well as a consultant relationship with Bayer Healthcare, Pfizer and Edwards Lifesciences. The other authors have no financial disclosures to report.
Patient consent Obtained.
Ethics approval All patients were screened as part of a prospective observational trial (LOBI-BBB, NCT02077582),which was approved by the Charité Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
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