Thrombus density measurement is promising but technical standards are needed

We read with interest the article by Mokin et al 'Thrombus density predicts successful recanalization with Solitaire stent retriever thrombectomy in acute ischemic stroke'.1 Based on their results, the authors conclude that thrombus density assessed by plain cranial CT scans predicts recanalization after Solitaire stent retriever thrombectomy for acute ischemic stroke. Some methodological shortcomings of this study may have led to erroneous interpretation of the results. The authors investigated patients treated solely by Solitaire stent retriever thrombectomy, which reduced the cohort to 41 patients, and does not represent current practice as stent retrievers are very often combined with preceding intravenous thrombolysis and additional intra-arterial recombinant tissue plasminogen activator administration.2

We are concerned about the assessment of thrombus density on non-contrast CT using 5 mm slice thickness. This technique is very insensitive for detecting proximal vessel occlusion using the hyperdense middle cerebral artery sign as a...

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