title: Intracranial Thrombus Morphology and Composition Undergoes Time-Dependent Changes in Acute Ischemic Stroke: A CT Densitometry Study.
abstract: The aim of our study was to assess whether cerebral artery clots undergo time-dependent morphological and compositional changes in acute ischemic stroke. We performed a retrospective chart review of patients admitted within 5 h from symptom onset to three European stroke centers and evaluated non-contrast-enhanced CT (NECT) for hyperdense artery signs (HAS) in 2565 scans. The occlusion site, density of HAS expressed in Hounsfield units (HU), area of HAS, and relative density (rHU) (HU clot/HU non-affected artery) were studied and related to time from symptom onset, clinical severity, stroke etiology, and laboratory parameters. A HAS was present in the middle cerebral artery (MCA) in 185 (7.2%) and further explored. The mean time from symptom onset to CT was 100 min (range 17-300). We found a time-dependent loss of density in the occluded M1 segment within the first 5 h (N= 118, 95% CI [-15, -2],p= 0.01). Further, the thrombus area in the M2 segment decreased with time (cubic trendN= 67, 95% CI [-63, -8],p= 0.02). Overall, and especially in the M2 segment, a lower clot area was associated with higher fibrinogen (-21.7%, 95% CI [-34.8, -5.8],p= 0.009). In conclusion, our results disclosed time-dependent changes of intracranial thrombi with regard to occlusion site, density and area.
authors.affiliation: Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, 5020 Salzburg, Austria. s.pikija@salk.at.
authors.forename: Slaven
authors.initials: S
authors.lastname: Pikija
authors.affiliation: Department of Neurology, Univerzitetni Klinični Center, 2000 Maribor, Slovenia. jozef_magdic@yahoo.com.
authors.forename: Jozef
authors.initials: J
authors.lastname: Magdic
authors.affiliation: Department for Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia. vtrkulja@mef.hr.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Trkulja
authors.affiliation: Department of Neurology, Bezirkskrankenhaus Lienz, 9900 Lienz, Austria. p.unterkreuter@kh-lienz.at.
authors.forename: Peter
authors.initials: P
authors.lastname: Unterkreuter
authors.affiliation: Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, 5020 Salzburg, Austria. j.mutzenbach@salk.at.
authors.forename: Johannes Sebastian
authors.initials: JS
authors.lastname: Mutzenbach
authors.affiliation: Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, 5020 Salzburg, Austria. h.novak@salk.at.
authors.forename: Helmut F
authors.initials: HF
authors.lastname: Novak
authors.affiliation: Division of Neuroradiology, Christian Doppler Medical Center, Paracelsus Medical University, 5020 Salzburg, Austria. f.weymayr@salk.at.
authors.forename: Friedrich
authors.initials: F
authors.lastname: Weymayr
authors.affiliation: Department of Psychiatry, Christian Doppler Medical Center, Paracelsus Medical University, 5020 Salzburg, Austria. l.hauer@salk.at.
authors.forename: Larissa
authors.initials: L
authors.lastname: Hauer
authors.affiliation: Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, 5020 Salzburg, Austria. j.sellner@salk.at.|Department of Neurology, Klinikum rechts der Isar, Technische Universität, 81675 München, Germany. j.sellner@salk.at.|Institute of Linguistics, University of Salzburg, 5020 Salzburg, Austria. j.sellner@salk.at.
authors.forename: Johann
authors.initials: J
authors.lastname: Sellner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D020767:Intracranial Thrombosis / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000473:pathology*; D059906:Neuroimaging; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000000981:diagnostic imaging / Q000473:pathology*; D014057:Tomography, X-Ray Computed
chemical_list: D015415:Biomarkers; D005340:Fibrinogen
keywords: acute ischemic stroke; atherosclerosis; biomarker; hyperdense artery sign; intracranial clot; neuroimaging; vascular disease