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Ischemic Stroke
Original research
Assessment of thrombus length in acute ischemic stroke by post-contrast magnetic resonance angiography
  1. Ramanan Ganeshan1,2,
  2. Alexander H Nave1,2,
  3. Jan F Scheitz1,2,
  4. Katharina A Schindlbeck2,
  5. Karl Georg Haeusler1,2,
  6. Christian H Nolte1,2,
  7. Kersten Villringer1,
  8. Jochen B Fiebach1
  1. 1 Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
  2. 2 Department of Neurology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
  1. Correspondence to Ramanan Ganeshan, Departmentof Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charitéplatz 1, Berlin 10117, Germany; ramanan.ganeshan{at}charite.de

Abstract

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
  • mri
  • stroke

https://doi.org/10.1136/neurintsurg-2017-013454

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    Footnotes

    • 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.