title: Antiplatelet Usage Impacts Clot Density in Acute Anterior Circulation Ischemic Stroke.
abstract: We explored whether clot density in middle cerebral artery (MCA) occlusion is related to clinical variables, stroke etiology, blood constituents, and prestroke medication. We performed a retrospective chart review of patients with acute ischemic stroke of the anterior circulation admitted to two Central European stroke centers. The acquisition of non-contrast enhanced CT (NECT) and CT angiography (CTA) within 4.5 h of symptom onset was obligatory. We assessed the site of MCA occlusion as well as density, area, and length of the clot in 150 patients. The Hounsfield unit values for the clot were divided with contralateral MCA segment to yield relative Hounsfield Unit ratio (rHU). The site of the vessel occlusion (M1 vs. M2) and antiplatelet usage, but not stroke etiology, significantly influenced rHU. We found an inverse correlation of rHU with erythrocyte count (p < 0.001). The multivariate analysis revealed that a higher rHU (i.e., clot being more hyperdense) was more likely with the use of antiplatelets (OR 4.24, CI 1.10-16.31, p = 0.036). Erythrocyte (OR 0.18, CI 0.05-0.55, p = 0.003), and thrombocyte counts (OR 0.99, CI 0.98-0.99, p = 0.029) were associated with odds for more hypodense clots (lower rHU). Our study disclosed that antiplatelet therapy impacts the composition of intracranial clots of the anterior circulation.
authors: Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg 5020, Austria. s.pikija@salk.at.
authors: Slaven
authors: S
authors: Pikija
authors: Department of Neurology, Univerzitetni Klinični Center, Maribor 2000, Slovenia. jozef_magdic@yahoo.com.
authors: Jozef
authors: J
authors: Magdic
authors: Department of Anesthesiology, General Hospital Varazdin, Varazdin 42000, Croatia. lukic.anita@yahoo.com.
authors: Anita
authors: A
authors: Lukic
authors: Department of Cardiac Surgery, Salzburger Landeskliniken, Paracelsus Medical University, Salzburg 5020, Austria. c.schreiber@salk.at.
authors: Catharina
authors: C
authors: Schreiber
authors: Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg 5020, Austria. j.mutzenbach@salk.at.
authors: Johannes Sebastian
authors: JS
authors: Mutzenbach
authors: Division of Neuroradiology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg 5020, Austria. ma.mccoy@salk.at.
authors: Mark R
authors: MR
authors: McCoy
authors: Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg 5020, Austria. j.sellner@salk.at.|Department of Neurology, Klinikum rechts der Isar, Technische Universität München, München 81675, Germany. j.sellner@salk.at.
authors: Johann
authors: J
authors: Sellner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001792:Blood Platelets / Q000473:pathology; D004906:Erythrocyte Count; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy / Q000473:pathology*; D014057:Tomography, X-Ray Computed
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: antiplatelets; clot; computed tomography; hyperdense artery sign; ischemic stroke