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Research ArticleAdult Brain
Open Access

Whole-Brain Susceptibility-Weighted Thrombus Imaging in Stroke: Fragmented Thrombi Predict Worse Outcome

P.P. Gratz, G. Schroth, J. Gralla, H.P. Mattle, U. Fischer, S. Jung, P. Mordasini, K. Hsieh, R.K. Verma, C. Weisstanner and M. El-Koussy
American Journal of Neuroradiology July 2015, 36 (7) 1277-1282; DOI: https://doi.org/10.3174/ajnr.A4275
P.P. Gratz
aFrom 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.)
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G. Schroth
aFrom 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.)
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J. Gralla
aFrom 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.)
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H.P. Mattle
bNeurology (H.P.M., U.F., S.J.), Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
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U. Fischer
bNeurology (H.P.M., U.F., S.J.), Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
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S. Jung
aFrom 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.)
bNeurology (H.P.M., U.F., S.J.), Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
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P. Mordasini
aFrom 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.)
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K. Hsieh
aFrom 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.)
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R.K. Verma
aFrom 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.)
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C. Weisstanner
aFrom 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.)
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M. El-Koussy
aFrom 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.)
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Abstract

BACKGROUND AND PURPOSE: 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.

MATERIALS AND 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.

ABBREVIATION:

SVS
susceptibility vessel sign
  • © 2015 by American Journal of Neuroradiology

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American Journal of Neuroradiology: 36 (7)
American Journal of Neuroradiology
Vol. 36, Issue 7
1 Jul 2015
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Whole-Brain Susceptibility-Weighted Thrombus Imaging in Stroke: Fragmented Thrombi Predict Worse Outcome
P.P. Gratz, G. Schroth, J. Gralla, H.P. Mattle, U. Fischer, S. Jung, P. Mordasini, K. Hsieh, R.K. Verma, C. Weisstanner, M. El-Koussy
American Journal of Neuroradiology Jul 2015, 36 (7) 1277-1282; DOI: 10.3174/ajnr.A4275

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Whole-Brain Susceptibility-Weighted Thrombus Imaging in Stroke: Fragmented Thrombi Predict Worse Outcome
P.P. Gratz, G. Schroth, J. Gralla, H.P. Mattle, U. Fischer, S. Jung, P. Mordasini, K. Hsieh, R.K. Verma, C. Weisstanner, M. El-Koussy
American Journal of Neuroradiology Jul 2015, 36 (7) 1277-1282; DOI: 10.3174/ajnr.A4275
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