RT Journal Article
SR Electronic
T1 The hyperdense vessel sign on CT predicts successful recanalization with the Merci device in acute ischemic stroke
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 289
OP 293
DO 10.1136/neurintsurg-2012-010313
VO 5
IS 4
A1 Michael T Froehler
A1 Satoshi Tateshima
A1 Gary Duckwiler
A1 Reza Jahan
A1 Nestor Gonzalez
A1 Fernando Vinuela
A1 David Liebeskind
A1 Jeffrey L Saver
A1 J Pablo Villablanca
A1 For the UCLA Stroke Investigators
YR 2013
UL http://jnis.bmj.com/content/5/4/289.abstract
AB Background The success of mechanical clot retrieval for acute ischemic stroke may be influenced by the characteristics of the occlusive thrombus. The thrombus can be partly characterized by CT, as the hyperdense vessel sign (HVS) suggests erythrocyte-rich clot whereas fibrin-rich clot may be isodense. We hypothesized that the physical clot characteristics that determine CT density may also determine likelihood of retrieval with the Merci device. Methods We reviewed all acute stroke cases initially imaged with non-contrast CT before attempted Merci clot retrieval at a single center between 2004 and 2010. Each CT was blindly assessed for the presence or absence of the HVS, and post-retrieval angiograms were blindly assessed for reperfusion using the TICI scale. Results Of 67 patients analyzed (mean age 69; median NIHSS 19; 61% female), the HVS was seen in 42, and no HVS was present in 25. Successful recanalization was achieved in 79% of patients with the HVS (33/42), but in only 36% (9/25) of patients without HVS (p=0.001). The HVS was the only significant predictor of recanalization while accounting for age, treatment with IV-tPA, clot location, stroke etiology, time to treatment, and number of retrieval attempts. Conclusion The HVS in acute ischemic stroke was strongly predictive of successful recanalization using the Merci device. The HVS may indicate thrombi that are less adhesive compared with isodense clots that are more resistant to mechanical retrieval. The absence of HVS on pre-treatment CT may thus suggest the need for a more aggressive or alternative therapeutic approach.