title: Whole-Brain Susceptibility-Weighted Thrombus Imaging in Stroke: Fragmented Thrombi Predict Worse Outcome.
abstract: OBJECTIVE
  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.
  
  
  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.
authors: From the Departments of Diagnostic and Interventional Neuroradiology (P.P.G., G.S., J.G., S.J., P.M., K.H., R.K.V., C.W., M.E.-K.).
authors: P P
authors: PP
authors: Gratz
authors: From the Departments of Diagnostic and Interventional Neuroradiology (P.P.G., G.S., J.G., S.J., P.M., K.H., R.K.V., C.W., M.E.-K.) gerhard.schroth@insel.ch.
authors: G
authors: G
authors: Schroth
authors: From the Departments of Diagnostic and Interventional Neuroradiology (P.P.G., G.S., J.G., S.J., P.M., K.H., R.K.V., C.W., M.E.-K.).
authors: J
authors: J
authors: Gralla
authors: Neurology (H.P.M., U.F., S.J.), Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
authors: H P
authors: HP
authors: Mattle
authors: Neurology (H.P.M., U.F., S.J.), Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
authors: U
authors: U
authors: Fischer
authors: From the Departments of Diagnostic and Interventional Neuroradiology (P.P.G., G.S., J.G., S.J., P.M., K.H., R.K.V., C.W., M.E.-K.) Neurology (H.P.M., U.F., S.J.), Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
authors: S
authors: S
authors: Jung
authors: From the Departments of Diagnostic and Interventional Neuroradiology (P.P.G., G.S., J.G., S.J., P.M., K.H., R.K.V., C.W., M.E.-K.).
authors: P
authors: P
authors: Mordasini
authors: From the Departments of Diagnostic and Interventional Neuroradiology (P.P.G., G.S., J.G., S.J., P.M., K.H., R.K.V., C.W., M.E.-K.).
authors: K
authors: K
authors: Hsieh
authors: From the Departments of Diagnostic and Interventional Neuroradiology (P.P.G., G.S., J.G., S.J., P.M., K.H., R.K.V., C.W., M.E.-K.).
authors: R K
authors: RK
authors: Verma
authors: From the Departments of Diagnostic and Interventional Neuroradiology (P.P.G., G.S., J.G., S.J., P.M., K.H., R.K.V., C.W., M.E.-K.).
authors: C
authors: C
authors: Weisstanner
authors: From the Departments of Diagnostic and Interventional Neuroradiology (P.P.G., G.S., J.G., S.J., P.M., K.H., R.K.V., C.W., M.E.-K.).
authors: M
authors: M
authors: El-Koussy
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography; D005260:Female; D005682:Gadolinium; D006801:Humans; D020767:Intracranial Thrombosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology*; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology*
chemical_list: D005682:Gadolinium