Proximal flow to middle cerebral artery is associated with higher thrombus density in terminal internal carotid artery occlusion

Abstract

Proximal collaterals may determine the composition of occluding thrombi in acute ischemic stroke (AIS) in addition to source, hematocrit, time, and medication. Here, we performed a retrospective study of 39 consecutive patients with radiological evidence of I‐, L‐, and T‐type terminal internal carotid artery occlusion. Middle cerebral artery (MCA) thrombus density was assessed on noncontrast enhanced CT and proximal collaterals on CT angiography. In patients with presence of proximal collaterals to the MCA we detected more hyperdense clots (P = 0.003) and a higher frequency of leptomeningeal collaterals (P = 0.008). We expand the spectrum of factors that potentially determine clot perviousness and evolution of ischemic stroke.

Branch-site occlusion sign predicts the embolic origin of acute ischemic stroke: a meta-analysis

“…None of the included studies fulfilled all the items of the QUADAS-2 checklist. Some studies did not report whether a consecutive or random sample of patients was enrolled ( 8 , 13 , 18 ); two studies did not mention whether the BSO sign was interpreted without knowledge of the results of the reference standard, and it was unclear if reviewers of the reference standard were blinded to the results of TTO sign ( Figure 2 ) ( 8 , 14 ).…”

“…Several methods, including the hyperdense artery sign, susceptibility vessel sign, fixed focal stenosis on follow-up imaging, histological examination of extracted clots, comprehensive cardiological evaluation after the lapse of the hyperacute stage, and intra-procedural angiographic signs (cut-off, tapered, and meniscus) could predict the pathogenesis of ILVO-AIS and response to first-line endovascular strategies ( 7 ). However, several studies have reported the relationship between the BSO sign and the etiology of ILVO-AIS ( 9 , 14 ). It was thought that the BSO sign could be an independent predictor of the underlying stroke mechanism and SR response.…”

“…(2) Therapeutic outcomes: They are defined as recanalization success (RS) by SR without RT. RS was defined as mTICI 2b-3 ( 9 , 10 , 14 ).…”