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- Title
Clinical impact of assessing thrombus age using magnetic resonance venography prior to catheter-directed thrombolysis.
- Authors
Arnoldussen, Carsten W. K. P.; Notten, Pascale; Brans, Rutger; Vroegindeweij, Dammis; Tick, Lidwine W.; van de Poel, Marlène H. W.; Wikkeling, Otmar R. M.; Vleming, Louis-Jean; Koster, Ad; Jie, Kon-Siong G.; Jacobs, Esther M. G.; Planken, Nils; Wittens, Cees H. A.; ten Cate, Hugo; Wildberger, Joachim E.; ten Cate-Hoek, Arina J.
- Abstract
Objectives: Magnetic resonance venography (MRV) is underutilized in the evaluation of thrombus properties prior to endovascular treatment but may improve procedural outcomes. We therefore investigated the clinical impact of using a dedicated MRV scoring system to assess thrombus characteristics prior to endovascular intervention for iliofemoral deep vein thrombosis (DVT). Methods: This is a post hoc analysis of data from the CAVA trial (Clinicaltrials.gov:NCT00970619). MRV studies of patients receiving ultrasound-accelerated catheter-directed thrombolysis (CDT) for iliofemoral DVT were reviewed. Thrombus age-related imaging characteristics were scored and translated into an overall score (acute, subacute, or old). MRV scores were compared to patient-reported complaints. MRV-scored groups were compared for CDT duration and success rate. Results: Fifty-six patients (29 men; age 50.8 ± 16.4 years) were included. Using MRV, 27 thrombi were classified acute, 17 subacute, and 12 old. Based on patient-reported complaints, 11 (91.7%) of these old thrombi would have been categorized acute or subacute, and one (3.7%) of the acute thrombi as old. Average duration of CDT to > 90% restored patency differed significantly between groups (p < 0.0001): average duration was 23 h for acute thromboses (range: 19–25), 43 h for subacute (range: 41–62), and 85 h for old thromboses (range: 74–96). CDT was almost eleven times more successful in thromboses characterized as acute and subacute compared to old thromboses (OR: 10.7; 95% CI 2.1–55.5). Conclusion: A dedicated MRV scoring system can safely discriminate between acute, subacute, and old thromboses. MRV-based selection is predictive of procedural duration and success rate and can help avoid unnecessary complications. Key Points: • Thrombus age, characterized by MRV as acute, subacute, and old, can predict CDT duration and probability of success. • Accurate pre-interventional MRV-based thrombus aging has the potential to facilitate identification of eligible patients and may thus prevent CDT-related complications.
- Publication
European Radiology, 2022, Vol 32, Issue 7, p4555
- ISSN
0938-7994
- Publication type
Article
- DOI
10.1007/s00330-022-08599-5