title: The importance of size: successful recanalization by intravenous thrombolysis in acute anterior stroke depends on thrombus length.
abstract: OBJECTIVE
  We hypothesize that in acute middle cerebral artery stroke, thrombus lengths measured in thin-slice nonenhanced CT images define a limit beyond which systemic thrombolysis will fail to recanalize occluded arteries.
  
  
  METHODS
  In 138 patients who presented with acute middle cerebral artery stroke and who were treated with intravenous thrombolysis (IVT), we measured lengths of thrombotic clots depicted as arterial hyperdensities in admission nonenhanced CT images with 2.5-mm slice width. Vascular recanalization was investigated after thrombolysis and recanalization results were related to thrombus lengths by logistic regression.
  
  
  RESULTS
  In 62 patients, IVT resulted in recanalization; among these patients, no thrombus length exceeded 8 mm. The median modified Rankin scale score at hospital discharge was 2. In the remaining 76 patients, thrombus lengths mostly exceeded 8 mm and IVT failed in recanalization. These patients were discharged with a median modified Rankin scale score of 5.
  
  
  CONCLUSIONS
  This study shows that in acute middle cerebral artery stroke, IVT has nearly no potential to recanalize occluded vessels if thrombus length exceeds 8 mm.
authors.affiliation: Department of Neuroradiology, University Clinics of Schleswig-Holstein, Arnold-Heller-Str.3, 24105 Kiel, Germany. c.riedel@neurorad.uni-kiel.de
authors.forename: Christian H
authors.initials: CH
authors.lastname: Riedel
authors.forename: Philip
authors.initials: P
authors.lastname: Zimmermann
authors.forename: Ulf
authors.initials: U
authors.lastname: Jensen-Kondering
authors.forename: Robert
authors.initials: R
authors.lastname: Stingele
authors.forename: Günther
authors.initials: G
authors.lastname: Deuschl
authors.forename: Olav
authors.initials: O
authors.lastname: Jansen
mesh_terms: D000368:Aged; D002548:Cerebral Revascularization; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000473:pathology* / Q000628:therapy*; D007262:Infusions, Intravenous; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000473:pathology* / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods; D013927:Thrombosis / Q000473:pathology*; D014057:Tomography, X-Ray Computed
chemical_list: D005343:Fibrinolytic Agents