Clinical impact of assessing thrombus age using magnetic resonance venography prior to catheter-directed thrombolysis
Carsten W K P Arnoldussen, Pascale Notten, Rutger Brans, Dammis Vroegindeweij, Lidwine W Tick, Marlène H W van de Poel, Otmar R M Wikkeling, Louis-Jean Vleming, Ad Koster, Kon-Siong G Jie, Esther M G Jacobs, Nils Planken, Cees H A Wittens, Hugo Ten Cate, Joachim E Wildberger, Arina J Ten Cate-Hoek, Carsten W K P Arnoldussen, Pascale Notten, Rutger Brans, Dammis Vroegindeweij, Lidwine W Tick, Marlène H W van de Poel, Otmar R M Wikkeling, Louis-Jean Vleming, Ad Koster, Kon-Siong G Jie, Esther M G Jacobs, Nils Planken, Cees H A Wittens, Hugo Ten Cate, Joachim E Wildberger, Arina J Ten Cate-Hoek
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.
Keywords: Magnetic resonance venography; Thrombolysis; Thrombosis; Thrombus.
Conflict of interest statement
The authors declare no competing interests.
© 2022. The Author(s).
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Source: PubMed