Frequency and clinical course of stroke and transient ischemic attack patients with intracranial nonocclusive thrombus on computed tomographic angiography.
OBJECTIVE
We sought to determine the frequency and clinical course of patients with acute ischemic stroke or transient ischemic attack (TIA) who had intracranial nonocclusive thrombus (iNOT) on CT angiography (CTA).


METHODS
We retrospectively (June 2002-March 2007) reviewed consecutive patients with acute ischemic stroke or TIA who had CTA performed acutely for diagnostic work-up. A neuroradiologist reviewed all cases with potential iNOT. Criteria to diagnose iNOT rather than occlusive thrombus or atherosclerotic stenosis were: (1) residual lumen present and eccentric; (2) nontapering thrombus; (3) smooth and well-defined thrombus margins; and (4) absence of vessel wall calcification. We defined functional independence at discharge as modified Rankin scale score </=2.


RESULTS
Of 865 patients, 23 (2.7%) exhibited iNOT on CTA (43% women, mean age 69+/-14 years, median National Institute of Health Stroke Scale score 3 [range, 0-23]; median onset-to-CTA time 3.5 hours [range, 0.9-75]). Four patients (17%) deteriorated clinically during the hospital course and had persistent new focal neurological deficits. All of them were functionally dependent at discharge. All 19 patients (83%) without persistent clinical deterioration (2 patients had recurrent TIAs) were functionally independent at discharge.


CONCLUSIONS
Intracranial nonocclusive thrombus on CTA is relatively uncommon. The majority of patients have a good clinical outcome. However, some patients deteriorate clinically and are functionally dependent at discharge.
Puetz
Volker
V
Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Room 1162, University of Calgary, Calgary, Canada.
Dzialowski
Imanuel
I
Coutts
Shelagh B
SB
Hill
Michael D
MD
Krol
Andrea
A
O'Reilly
Christine
C
Goyal
Mayank
M
Demchuk
Andrew M
AM
D000368:Aged; D002536:Cerebral Arteries / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D015897:Comorbidity; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D020767:Intracranial Thrombosis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D002546:Ischemic Attack, Transient / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*