title: Fibrinogen consumption is related to intracranial clot burden in acute ischemic stroke: a retrospective hyperdense artery study.
abstract: Understanding the underlying mechanism of thrombus formation and its components is critical for effective prevention and treatment of ischemic stroke. The generation of thrombotic clots requires conversion of soluble fibrinogen to an insoluble fibrin network. Quantitative features of intracranial clots causing acute ischemic stroke can be studied on non-contrast enhanced CT (NECT). Here, we evaluated on-admission fibrinogen and clot burden in relation to stroke severity, final infarct volume and in-hospital mortality.
  
  
  
  We included 132 consecutive patients with ischemic stroke and presence of hyperdense artery sign admitted within 6 h from symptom onset. Radiological parameters including clot area (corresponding to clot burden) and final infarct volume were manually determined on NECT. National Institute of Health Stroke Scale (NIHSS) was used to quantify disease severity and short-term outcome.
  
  
  
  Median patient age was 77, 58 % were women, and 63 % had an occlusion of the proximal middle cerebral artery segment. Thrombolysis was performed in 60 % and thrombectomy in 44 %. We identified several independent associations. Higher fibrinogen levels on admission were associated with smaller clot burden (p = 0.033) and lower NIHSS on admission (p = 0.022). Patients with lower fibrinogen had a higher clot burden (p = 0.028) and greater final infarct volume (p = 0.003). Higher fibrinogen was associated with a lower risk of in-hospital death or NIHSS score >15 if discharged alive (p = 0.028).
  
  
  
  Our study suggests that intracranial clot burden in acute ischemic stroke is associated with fibrinogen consumption, and shows a complex relationship with disease severity, infarct size and in-hospital survival.
authors: Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria.
authors: Slaven
authors: S
authors: Pikija
authors: Department for Pharmacology, School of Medicine, University of Zagreb, Zagreb, Croatia.
authors: Vladimir
authors: V
authors: Trkulja
authors: Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria.
authors: Johannes Sebastian
authors: JS
authors: Mutzenbach
authors: Division of Neuroradiology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.
authors: Mark R
authors: MR
authors: McCoy
authors: Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria.
authors: Patricia
authors: P
authors: Ganger
authors: Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria. j.sellner@salk.at.|Department of Neurology, Klinikum rechts der Isar, Technische Universität München, München, Germany. j.sellner@salk.at.
authors: Johann
authors: J
authors: Sellner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications* / Q000378:metabolism*; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D017052:Hospital Mortality; D006801:Humans; D020767:Intracranial Thrombosis / Q000150:complications* / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010343:Patient Admission; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications* / Q000378:metabolism*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005340:Fibrinogen
keywords: Clot burden; Computed tomography; Fibrinogen; Hyperdense artery; Ischemic stroke