Letter by Wanklyn et al Regarding Article, “Clot Length Distribution and Predictors in Anterior Circulation Stroke: Implications for Intra-Arterial Therapy”

The recent article by Kamalian et al1 shows that longer clots are associated with a high probability of terminal internal carotid artery or M1 segment occlusion. They argue for more rapid delivery of intra-arterial therapy and clot removal in these cases, yet this therapy is still being evaluated in ongoing trials (eg, Pragmatic Ischaemic Stroke Thrombectomy Evaluation [PISTE]). It has been established that clinical outcome after ischemic stroke is proportional to recanalization rates and time to achieve this event. In turn, recanalization rates depend on the site and length of the thrombus. Riedel et al2 reported in their retrospective series of 138 patients given intravenous recombinant tissue-type plasminogen activator (rtPA) that there were no cases of recanalization if thrombus length exceeded 8 mm. This is widely quoted and could lead …