Introduction/purpose Data on the predictive value of thrombus characteristics on initial CT imaging and radiologic outcomes is conflicting in stroke patients treated with endovascular thrombectomy (EVT). We aimed to evaluate the association between thrombus CT characteristics and successful recanalization in patients with acute large vessel occlusive stroke treated with EVT.

Materials and methods We performed a retrospective study using a prospectively maintained database of individuals with acute ischemic stroke admitted to the neurointensive care unit at Detroit Medical Center between 2014–2017. Patients with confirmed large vessel occlusion (LVO) treated with EVT were included. Primary outcome successful recanalization defined as TICI2b/3. Data was recorded for baseline risk factors, initial NIHSS, time-to-treatment, tPA administration, as well as initial CT findings including hyperdense artery sign (HAS), thrombus length (millimeter) and thrombus density (absolute Hounsfield unit values). Independent two-sample T-test and Fisher’s exact test were used to investigate the association between thrombus CT characteristics and successful recanalization.

Results Overall 74 patients with LVO strokes (age 67.75+13.38, 44% female) treated with EVT were included. Successful recanalization was achieved in 72.6% of patients. HAS was present in 54% and intravenous tPA was administered in 37% of patients as adjunctive therapy. Baseline clinical characteristics including hypertension, diabetes, atrial fibrillation, initial NIHSS as well as tPA administration (p=0.5) or presence of HAS (p=0.7) were not predictive of successful recanalization. Thrombus density values were comparable in those with and without successful recanalization (61.6±1.7 vs 61.0±3.2, p=0.8, respectively). Greater thrombus length was a significant predictor for non-recanalization following EVT (34.3±12.4 vs 17.5±01.9, p=0.03 for thrombus length in TICI 0–2a vs TICI 2b/3 groups, respectively).

Conclusions We observed that thrombus length but not thrombus density or tPA administration are predictive of successful recanalization in LVO treated with EVT.

Disclosures H. Saber: None. J. Kinariwala: None. G. Rajah: None. S. Narayanan: None. A. Luqman: None. M. Ibrahim: None. K. Suchdev: None.