| Abstract: | BACKGROUND AND PURPOSE:The susceptibility vessel sign on MR imaging has been reported to indicate acute occlusion from erythrocyte-rich thrombus. The purpose of this study was to evaluate the influence of the susceptibility vessel sign seen on MR imaging before treatment on the clinical outcome after mechanical thrombectomy for anterior circulation acute stroke.MATERIALS AND METHODS:We retrospectively included 73 consecutive patients who were treated for anterior circulation acute stroke by mechanical thrombectomy from December 2009 to September 2013. Each patient underwent MR imaging before mechanical thrombectomy. The presence (susceptibility vessel sign+) or absence of the susceptibility vessel sign (susceptibility vessel sign−) was recorded. Mechanical thrombectomy was performed either alone or in association with IV tPA according to the site and time after occlusion. Good functional outcome was defined by an mRS ≤2 at 3 months in susceptibility vessel sign+ and susceptibility vessel sign− groups. Patient clinical characteristics, initial NIHSS score and ASPECTS, site of occlusion, time between onset to groin puncture, TICI after mechanical thrombectomy, NIHSS score at day 1, and spontaneous hyperattenuation on CT at day 1 were also analyzed.RESULTS:Fifty-three patients with susceptibility vessel sign+ and 20 with susceptibility vessel sign− were included in our study. mRS ≤2 at 3 months occurred in 65% patients in the susceptibility vessel sign+ group and 26% in the susceptibility vessel sign− group (P = .004). On multivariate analysis, the susceptibility vessel sign was the only parameter before treatment that could predict mRS ≤2 at 3 months (OR, 8.7; 95% CI, 1.1–69.4; P = .04).CONCLUSIONS:Our study strongly suggests that the susceptibility vessel sign on MR imaging before treatment is predictive of favorable clinical outcome for patients presenting with anterior circulation acute stroke and treated with mechanical thrombectomy.Stroke is a leading cause of adult disability. Approximately two-thirds of stroke survivors have long-term functional deficits that affect their quality of life.1,2 Very recently, large prospective randomized trials have proved the clinical benefit of endovascular recanalization and, in particular, mechanical thrombectomy (MT) in patients with proximal anterior circulation acute stroke (ACAS).3,4 In these studies, patients were included on the basis of the presence of a proximal artery occlusion without any characterization of thrombus subtypes (ie, fibrin-rich or erythrocyte-rich thrombus). A gradient recalled-echo (GRE) MR imaging sequence is commonly used to identify brain hemorrhage, and it may also differentiate fibrin-rich from erythrocyte-rich thrombus on the basis of the presence of a susceptibility vessel sign (SVS).5,6There has been no study addressing the prognostic value of SVS in predicting good clinical recovery after MT, to our knowledge. The goal of our study was, therefore, to investigate whether the presence of the SVS is related to better clinical outcomes after MT with stent retrievers in patients presenting with ACAS. |
