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

Gratz, P P; Schroth, Gerhard; Gralla, Jan; Mattle, Heinrich; Fischer, Urs; Jung, Simon; Mordasini, Pasquale; Hsieh, Kety Wha-Vei; Verma, Rajeev Kumar; Weisstanner, Christian; El-Koussy, Marwan (2015). Whole-Brain Susceptibility-Weighted Thrombus Imaging in Stroke: Fragmented Thrombi Predict Worse Outcome. AJNR. American journal of neuroradiology, 36(7), pp. 1277-1282. 10.3174/ajnr.A4275

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Schroth, Gerhard; Gralla, Jan; Mattle, Heinrich; Fischer, Urs; Jung, Simon; Mordasini, Pasquale; Hsieh, Kety Wha-Vei; Verma, Rajeev Kumar; Weisstanner, Christian and El-Koussy, Marwan

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1936-959X

Language:

English

Submitter:

Martin Zbinden

Date Deposited:

07 Apr 2015 15:51

Last Modified:

29 Dec 2017 09:51

Publisher DOI:

10.3174/ajnr.A4275

PubMed ID:

25792535

BORIS DOI:

10.7892/boris.66226

URI:

https://boris.unibe.ch/id/eprint/66226

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