Clot Length Assessment in Stroke Therapy Decisions

See related article, p 756. Identifying suitable patients for reperfusion therapies using imaging parameters is an exciting but controversial field of research. Numerous prognostic markers have been proposed, yet few modify the risk–benefit of reperfusion sufficiently to alter a decision to treat. The study by Yan et al1 uses gadolinium-enhanced T1 magnetic resonance imaging to measure clot length as a potential biomarker of responsiveness to alteplase. The authors found that longer clots were less likely to recanalize with intravenous thrombolysis. The particular method using a gadolinium-enhanced T1 sequence allows a more accurate measure of clot length than susceptibility-weighted imaging because of a lack of blooming artifact that is generated by hemosiderin on T2*-weighted imaging. It also overcomes the difficulties of …