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Whole-Brain Susceptibility-Weighted Thrombus Imaging in Stroke: Fragmented Thrombi Predict Worse Outcome

Authors :
Jan Gralla
Kety Hsieh
Heinrich Mattle
Urs Fischer
Christian Weisstanner
Pasquale Mordasini
Gerhard Schroth
Rajeev Kumar Verma
Simon Jung
Pascal P. Gratz
Marwan El-Koussy
Source :
AJNR Am J Neuroradiol
Publication Year :
2015

Abstract

BACKGROUND AND PURPOSE: The prevalence and clinical importance of primarily fragmented thrombi in patients with acute ischemic stroke remains elusive. Whole-brain SWI was used to detect multiple thrombus fragments, and their clinical significance was analyzed. MATERIALS AND METHODS: Pretreatment SWI was analyzed for the presence of a single intracranial thrombus or multiple intracranial thrombi. Associations with baseline clinical characteristics, complications, and clinical outcome were studied. RESULTS: Single intracranial thrombi were detected in 300 (92.6%), and multiple thrombi, in 24 of 324 patients (7.4%). In 23 patients with multiple thrombi, all thrombus fragments were located in the vascular territory distal to the primary occluding thrombus; in 1 patient, thrombi were found both in the anterior and posterior circulation. Only a minority of thrombus fragments were detected on TOF-MRA, first-pass gadolinium-enhanced MRA, or DSA. Patients with multiple intracranial thrombi presented with more severe symptoms (median NIHSS scores, 15 versus 11; P = .014) and larger ischemic areas (median DWI ASPECTS, 5 versus 7; P = .006); good collaterals, rated on DSA, were fewer than those in patients with a single thrombus (21.1% versus 44.2%, P = .051). The presence of multiple thrombi was a predictor of unfavorable outcome at 3 months ( P = .040; OR, 0.251; 95% CI, 0.067–0.939). CONCLUSIONS: Patients with multiple intracranial thrombus fragments constitute a small subgroup of patients with stroke with a worse outcome than patients with single thrombi.

Details

Language :
English
Database :
OpenAIRE
Journal :
AJNR Am J Neuroradiol
Accession number :
edsair.doi.dedup.....59f219e4bd980b279b33ebeb359349d9
Full Text :
https://doi.org/10.7892/boris.66226