Clinical impact of assessing thrombus age using magnetic resonance venography prior to catheter-directed thrombolysis

• Published in: European radiology 2022-07, Vol.32 (7), p.4555-4564
• Main 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.
• Format: Article
• Language: English
• Subjects: Age; Aging; Blood clots; Cardiovascular system; Catheters; Complications; Diagnostic Radiology; Imaging; Internal Medicine; Interventional Radiology; Magnetic Resonance; Medical instruments; Medicine; Medicine & Public Health; Neuroradiology; Patients; Radiology; Resonance; Success; Thromboembolism; Thrombolysis; Thrombosis; Ultrasound
• ISSN: 1432-1084; 0938-7994; 1432-1084
• DOI: 10.1007/s00330-022-08599-5

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.