PT  - JOURNAL ARTICLE
AU  - Gratz, P.P.
AU  - Schroth, G.
AU  - Gralla, J.
AU  - Mattle, H.P.
AU  - Fischer, U.
AU  - Jung, S.
AU  - Mordasini, P.
AU  - Hsieh, K.
AU  - Verma, R.K.
AU  - Weisstanner, C.
AU  - El-Koussy, M.
TI  - Whole-Brain Susceptibility-Weighted Thrombus Imaging in Stroke: Fragmented Thrombi Predict Worse Outcome
AID  - 10.3174/ajnr.A4275
DP  - 2015 Jul 01
TA  - American Journal of Neuroradiology
PG  - 1277--1282
VI  - 36
IP  - 7
4099  - http://www.ajnr.org/content/36/7/1277.short
4100  - http://www.ajnr.org/content/36/7/1277.full
SO  - Am. J. Neuroradiol.2015 Jul 01; 36
AB  - 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.SVSsusceptibility vessel sign