Thrombus Density Predicts Successful Recanalization With Stent-Retriever Thrombectomy In Acute Ischemic Stroke (P4.215)

OBJECTIVE The goal of our study was to analyze the prognostic value of thrombus characteristics on the ability of stent retrievers to achieve successful recanalization in stroke. BACKGROUND Thrombus characteristics including Hounsfield unit (HU) value to measure density and thrombus volume and length can predict successful recanalization in intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA). Conflicting and limited data exist regarding the value of assessing thrombus properties in acute stroke cases treated with endovascular intraarterial approaches. DESIGN/METHODS We retrospectively reviewed cases of anterior circulation acute ischemic stroke in which a Solitaire stent retriever was the primary treatment device. We measured the following thrombus characteristics: absolute and corrected HU values, thrombus length and volume, clot burden score and vessel bifurcation involvement. Fisher’s exact test and t-test were used to study the association between these clot characteristics and successful recanalization (defined as Thrombolysis in Cerebral Infarction [TICI] score 2a-3 RESULTS We identified 41 patients with anterior circulation stroke treated with the Solitaire stent retriever as the primary treatment device. Successful recanalization (TICI score 2a-3) was achieved in 80% of cases. Higher absolute and corrected HU values were strongly predictive of successful recanalization (49.8 ± 7.7 versus 42.0±5 .9, P=0.01 for absolute HU values and 1.2 ± 0.2 versus 1.0 ± 0.1, P=0.018 for rHU in TICI 2a-3 and TICI 1-0 groups, respectively). There was no significant difference between the recanalization and nonrecanalization groups in other thrombus characteristics, such as thrombus volume, length, involvement of arterial bifurcations or clot burden score values. CONCLUSIONS In acute stroke treated with Solitaire stent-retriever thrombectomy, higher thrombus HU values are predictive of successful recanalization. Such information can be used in the decision-making process when estimating recanalization success rate with different endovascular treatment approaches. Disclosure: Dr. Mokin has received research support from Toshiba. Dr. Morr has nothing to disclose. Dr. Natarajan has nothing to disclose. Dr. Siddiqui has received personal compensation for activities with Codman & Shurtleff Inc., Concentric Medical, ev3/Covidien Vascular Therapies, Penumbra and Micrus Endovascular, GuidePoint Global Consulting, Genentech Inc, Abbott Vascular, American Association of Neurological Surgeons, Neocure Group LLC, and Stryker Neurovascular. Dr. Siddiqui holds stock and/or stock options in Hotspur, Intratech Medical, Valor Medical, which sponsored research in which Dr. Siddiqui was involved as an investigator. Dr. Levy has received personal compensation for activities with Cordis Neurovascular, Micrus Endovascular, Abbott Vascular, ev3, and Covidien Vascular. Dr. Levy has received royalty, license fee, or contractual rights payments from Intratech Medical Ltd. and Mynx/Access Closure. Dr. Levy has received research support from Stent-Assisted Recanalization in Acute Ischemic Stroke, Micrus Endovascular, ev3/Covidien Vascular, and other research support.