Thrombus Histology of Basilar Artery Occlusions

Berndt, Maria; Poppert, Holger; Steiger, Katja; Pelisek, Jaroslav; Oberdieck, Paul; Maegerlein, Christian; Zimmer, Claus; Wunderlich, Silke; Friedrich, Benjamin; Boeckh‐Behrens, Tobias; Ikenberg, Benno

doi:10.1007/s00062-020-00964-5

Cited by 12 publications

(4 citation statements)

References 31 publications

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“…Instead, we examined the relationship between TP and stroke etiology defined by TOAST criteria and found no significant association, neither in a univariable analysis nor in a multivariable analysis. These results are in line with findings from a recent study, which—in contrast to patients with M1 occlusions ( 6 )—found no association between histological thrombus composition and stroke etiology in patients with BAO ( 12 ). The available evidence therefore suggests that the potential role of TP measurements to guide determination of stroke etiology might be limited to occlusions in the anterior circulation.…”

Section: Discussionsupporting

confidence: 92%

No Association Between Thrombus Perviousness and Cardioembolic Stroke Etiology in Basilar Artery Occlusion Stroke

et al. 2021

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Background: Thrombus perviousness (TP) quantified by thrombus attenuation increase (TAI) assessed on acute non-contrast computed tomography (NCCT) and CT angiography (CTA) may be associated with stroke etiology in anterior circulation ischemic stroke. We investigated whether TP is associated with stroke etiology and recanalization after mechanical thrombectomy in patients with acute basilar artery occlusion (BAO).Methods: Eighty patients with complete BAO and in-house acute imaging from a prospectively maintained database were included. Two raters independently segmented the complete thrombus on co-registered NCCT and CTA to determine TAI in Hounsfield units (HUCTA–HUNCCT); averaged values of the raters were used for analysis. Recanalization to modified treatment in cerebral ischemia (mTICI) score 2b/3 was considered successful, and 90-day modified Rankin Scale score 0–2 was considered favorable.Results: TAI did not differ between patients with different stroke etiologies; median TAI in patients with cardioembolic stroke (n = 36) was −0.47 (interquartile range −4.08 to 7.72), 1.94 (−8.14 to 10.75) in patients with large artery atherosclerosis (LAA; n = 25), and −0.99 (−6.49 to 5.40) in patients with stroke of undetermined origin (n = 17; p = 0.955). Binary logistic regression analyses did not identify TAI as an independent indicator of cardioembolic stroke (adjusted odds ratio [OR] vs. LAA stroke: 1.0 [95% CI: 0.95–1.0], p = 0.751). There was no association with successful recanalization (adjusted OR 1.4 [0.70–2.7], p = 0.345) or favorable outcome (adjusted OR 1.1 [95% CI: 0.94–1.2], p = 0.304).Conclusion: In contrast to proximal middle cerebral artery occlusions, TP in BAO patients is not associated with cardioembolic stroke etiology. Larger confirmatory studies to establish the potential role of TP for clinical applications should focus on patients with anterior circulation stroke.

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Section: Discussionsupporting

confidence: 92%

No Association Between Thrombus Perviousness and Cardioembolic Stroke Etiology in Basilar Artery Occlusion Stroke

et al. 2021

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“…Patients with stroke were treated at our comprehensive stroke center as described previously following local standard operating procedures in accordance with national guidelines. 21 Diagnostic workup of stroke cause included at least one long-term Holter-ECG monitoring, extracerebral and transcerebral duplex sonography of the brain supplying arteries, transthoracic echocardiography, and laboratory workup determining cardiovascular risk factors such as lipid status and hyperglycemia.…”

Section: Methodsmentioning

confidence: 99%

Bony Stroke: Ischemic Stroke Caused by Mechanical Stress on Brain Supplying Arteries From Anatomical Bone or Cartilage Anomalies

Haertl

Renz

Wunderlich

et al. 2023

Stroke

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Background: Bone or cartilage anomalies with affection of brain supplying arteries are a potential structural cause for ischemic stroke. In the following, we termed this entity bony stroke. Due to rarity of their description, there is no standardized workup and therapy for bony strokes. Methods: Retrospectively, we extracted diagnostic and therapeutic workup of all patients considered to have had a bony stroke between January 2017 to March 2022 at our comprehensive care center. Results: In total, 6 patients classified as a bony stroke were identified among 4200 acute patients with ischemic stroke treated during the study period. Each patient had recurrent ischemic strokes in the dependent vascular territory before diagnosis. Diagnosis was achieved by a combination of imaging devices, including sonography, computed tomography, and magnetic resonance imaging. In addition to conventional static imaging, the application of dynamic imaging modalities with the patients’ head in rotation or reclination confirmed a vessel affection following head movements in 3 patients (50%). Treatment options were interdisciplinary assessed and included the following: conservative treatment (n=1), endovascular stenting (n=2) or occlusion (n=2), surgical removal of bone/ cartilage (n=2), and surgical bypass treatment (n=1). In follow-up (mean 11.7 months), no patient experienced further ischemia. Conclusions: As a differential diagnosis, bony strokes may be considered in patients with recurrent ischemic stroke of unknown cause in one dependent vascular territory. Interdisciplinary evaluation and treatment may eliminate risk of stroke recurrence.

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“…This discrepancy stems from the unique anatomical and hemodynamic characteristics of the posterior circulation. Features such as reduced flow speeds, variance in vessel diameter, and even disparities in clot formations contribute to distinct stroke origins and progressions in comparison to their anterior circulation counterparts [60,61]. It is worth noting that the standard FAST stroke recognition tool, which comprises face asymmetry, arm weakness, and speech irregularities, does not consistently detect PCS.…”

Section: Onset and Recognitionmentioning

confidence: 99%

Integrative Approaches in Acute Ischemic Stroke: From Symptom Recognition to Future Innovations

Saceleanu,

Toader,

Ples

et al. 2023

Biomedicines

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Among the high prevalence of cerebrovascular diseases nowadays, acute ischemic stroke stands out, representing a significant worldwide health issue with important socio-economic implications. Prompt diagnosis and intervention are important milestones for the management of this multifaceted pathology, making understanding the various stroke-onset symptoms crucial. A key role in acute ischemic stroke management is emphasizing the essential role of a multi-disciplinary team, therefore, increasing the efficiency of recognition and treatment. Neuroimaging and neuroradiology have evolved dramatically over the years, with multiple approaches that provide a higher understanding of the morphological aspects as well as timely recognition of cerebral artery occlusions for effective therapy planning. Regarding the treatment matter, the pharmacological approach, particularly fibrinolytic therapy, has its merits and challenges. Endovascular thrombectomy, a game-changer in stroke management, has witnessed significant advances, with technologies like stent retrievers and aspiration catheters playing pivotal roles. For select patients, combining pharmacological and endovascular strategies offers evidence-backed benefits. The aim of our comprehensive study on acute ischemic stroke is to efficiently compare the current therapies, recognize novel possibilities from the literature, and describe the state of the art in the interdisciplinary approach to acute ischemic stroke. As we aspire for holistic patient management, the emphasis is not just on medical intervention but also on physical therapy, mental health, and community engagement. The future holds promising innovations, with artificial intelligence poised to reshape stroke diagnostics and treatments. Bridging the gap between groundbreaking research and clinical practice remains a challenge, urging continuous collaboration and research.

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Thrombus Histology of Basilar Artery Occlusions

Cited by 12 publications

References 31 publications

No Association Between Thrombus Perviousness and Cardioembolic Stroke Etiology in Basilar Artery Occlusion Stroke

No Association Between Thrombus Perviousness and Cardioembolic Stroke Etiology in Basilar Artery Occlusion Stroke

Bony Stroke: Ischemic Stroke Caused by Mechanical Stress on Brain Supplying Arteries From Anatomical Bone or Cartilage Anomalies

Integrative Approaches in Acute Ischemic Stroke: From Symptom Recognition to Future Innovations

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