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

Stroke. 2019 Feb;50(2):512-515. 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.

Keywords: magnetic resonance imagning; stroke; susceptibility vessel sign; thrombectomy; thrombus.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cerebral Infarction* / diagnostic imaging
  • Cerebral Infarction* / physiopathology
  • Cerebral Infarction* / surgery
  • Cerebral Revascularization*
  • Databases, Factual*
  • Humans
  • Magnetic Resonance Angiography*
  • Middle Aged
  • Predictive Value of Tests
  • Retrospective Studies
  • Stroke* / diagnostic imaging
  • Stroke* / physiopathology
  • Stroke* / surgery