Background and purpose Recent studies have demonstrated that in acute ischemic stroke patients, thin section non-contrast CT (NCCT) can be used to determine the length of the hyperdense intracranial thrombus, and that clot length using this approach predicts the likelihood of vessel recanalization after intravenous tissue plasminogen activator.

Summary of case An acute ischemic stroke patient presented with a left middle cerebral artery occlusion and underwent emergent catheter based therapy. Clot length was determined using pretreatment thin section NCCT and was independently confirmed by the pathologist after whole clot extraction.

Conclusions The concordance between the NCCT measured clot length and the pathological examination in this case provides additional support for the accuracy of using thin section NCCT data to determine clot length in all patients.