Does thrombus imaging characteristics predict the degree of recanalisation after endovascular thrombectomy in acute ischaemic stroke?

Background: Identification of computed tomography (CT) thrombus imaging charac-teristics can predict the degree of recanalization and outcome after endovascular thrombectomy (EVT) in patients with acute ischaemic stroke and large vessel occlu-sion. Aim: We analyzed the thrombus imaging characteristics and procedural fac-tors and correlated with the degree of recanalization and functional outcome after EVT. Methods: We evaluated the thrombus imaging characteristics (hyperdense MCA sign, thrombus location, length and thrombus permeability) from thin slice CT and CT angiogram. In addition, groin to recanalization time, number of passes, and EVT technique were documented. The primary outcome was degree of recana-lization (mTICI score) and secondary outcome was modified Rankin scale (mRS) at 3 months. Results: The mean age of 102 patients was 60.5 +/- 11.8 years. Patients with hyperdense MCA sign (90 % vs 75%, p=0.07) and permeable thrombus (86 % vs 70 %, p=0.09) had good recanalization (mTICI grade 2b,2c or 3). The requirement of <3 passes (90 % vs 62 %, p= 0.001) was associated with good recanalization. Multi-ple logistic regression analysis showed thrombus permeability (OR 5.9; 95% CI 1.3-26.6, p=0.02), use of stent retreiver alone (without aspiration) (OR 5.4; 95% CI 1.3-22.5, p=0.02) and a puncture to recanalization <60 minutes (OR 7.9; 95% CI 1.7-36.8; p=0.008) were associated with good recanalization. The requirement of >3 passes was associated with poor functional outcome (OR 3.4;95% CI 1.2-9.8; p=0.02). Conclusions: Thrombus permeability was a predictor of successful recanalization after EVT. The requirement of three or more passes during EVT was associated with recanalization and functional outcome.