Predictive Value of Susceptibility Vessel Sign for Arterial Recanalization and Clinical Improvement in Ischemic Stroke

• Published in: Stroke (1970) Vol. 50; no. 2; pp. 512 - 515
• Main Authors: Darcourt, Jean, Withayasuk, Pattarawit, Vukasinovic, Ivan, Michelozzi, Caterina, Bellanger, Guillaume, Guenego, Adrien, Adam, Gilles, Roques, Margaux, Januel, Anne Christine, Tall, Philippe, Meyrignac, Olivier, Rousseau, Vanessa, Garcia, Cédric, Albucher, Jean François, Payrastre, Bernard, Bonneville, Fabrice, Olivot, Jean Marc, Cognard, Christophe
• Format: Journal Article
• Language: English
• Published: United States American Heart Association, Inc 01.02.2019; American Heart Association
• Subjects: Aged; Aged, 80 and over; Cardiology and cardiovascular system; Cerebral Infarction - diagnostic imaging; Cerebral Infarction - physiopathology; Cerebral Infarction - surgery; Cerebral Revascularization; Databases, Factual; Human health and pathology; Humans; Life Sciences; Magnetic Resonance Angiography; Middle Aged; Predictive Value of Tests; Retrospective Studies; Stroke - diagnostic imaging; Stroke - physiopathology; Stroke - surgery; magnetic resonance imagning; susceptibility vessel sign; thrombus; stroke; thrombectomy
• ISSN: 0039-2499; 1524-4628; 1524-4628
• DOI: 10.1161/STROKEAHA.118.022912

BACKGROUND AND PURPOSE—Our goal was to evaluate whether the presence of a low signal intensity known as susceptibility vessel sign (SVS) on T2*-gradient echo imaging sequence was predictive of arterial recanalization and the early clinical improvement after mechanical thrombectomy. METHODS—This observational study was based on a prospective database of acute ischemic strokes treated by mechanical thrombectomy. Inclusion criteria were patients with acute anterior ischemic stroke, diagnosed by magnetic resonance imaging, including a T2*-gradient echo imaging sequence, and treated by mechanical thrombectomy. Two independent readers assessed the presence of an SVS. Successful recanalization was defined as a Thrombolysis in Cerebral Infarction score of 2b-3 after mechanical thrombectomy. Early clinical improvement was estimated by the difference between the baseline National Institutes of Health Stroke Scale and the National Institutes of Health Stroke Scale on day 1 after treatment RESULTS—The SVS was detected in 137 (76%) out of 180 patients. The kappa interrater agreement was 0.71 with a 95% CI of 0.59 to 0.82. Successful recanalization was associated with an SVS+ with odds ratio, 2.48; 95% CI, 1.05–5.74; P=0.03. The early clinical improvement was better in patients with an SVS+ (median, −6; interquartile range, −11 to 0) compared with SVS− patients (median, −1; interquartile range, −10 to 3) with P=0.01. CONCLUSIONS—The visualization of SVS is a reliable and easily accessible predictive factor of recanalization success and early clinical improvement.