Visualization of Clot Composition in Ischemic Stroke

Minnerup, Jens; Kleinschnitz, Christoph

doi:10.1161/strokeaha.110.612150

Cited by 26 publications

(30 citation statements)

References 12 publications

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“…4 These low-pressure systems include cardiac cul-de-sacs or venous systems. 4,14 In contrast, "white clots" or platelet-rich clots form in highpressure systems, mainly in the arteries.…”

Section: Discussionmentioning

confidence: 99%

“…4 These low-pressure systems include cardiac cul-de-sacs or venous systems. 4,14 In contrast, "white clots" or platelet-rich clots form in highpressure systems, mainly in the arteries. 4,14 Previous studies have shown that the presence of the hyperdense sign on NCCT and blooming artifacts on GRE are due to RBC-rich "red clots."…”

Section: Discussionmentioning

confidence: 99%

“…The hyperdense sign on noncontrast computed tomography (NCCT) and blooming artifact on gradient recalled echo (GRE) are known to be markers of clot within the cerebral arterial tree. [1][2][3][4][5][6][7][8] Previous studies have tried to correlate these imaging characteristics with the primary source of clot formation (cardiac vs large artery or in-situ), albeit with varying results. 2,3,5,9 There is evidence to show that clots that are red blood cell (RBC) rich are hyperdense on NCCT.…”

mentioning

confidence: 99%

“…2,3,5,9 There is evidence to show that clots that are red blood cell (RBC) rich are hyperdense on NCCT. 2,4 They also tend to bloom more on GRE because of increased deoxy-hemoglobin content. 2,10,11 We hypothesize that clot within the cerebral arterial tree consists of two components: (1) the "original clot" that comes either from a proximal source or is formed in-situ due to luminal disease and (2) new clot formation resulting from stasis of blood flow around this "original clot" (Figure 1).…”

mentioning

confidence: 99%

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Thrombus Characteristics Are Related to Collaterals and Angioarchitecture in Acute Stroke

Qazi

Sohn

Mishra

et al. 2015

Can. J. Neurol. Sci.

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Background: We have theorized that clots with stasis are longer. We therefore explored the relationship between thrombus imaging characteristics on noncontrast computed tomography (NCCT) and magnetic resonance imaging (MRI) with clot length and pial collaterals on baseline computed tomography angiography (CTA). Methods: Prospective study of acute ischemic stroke patients (2005)(2006)(2007)(2008)(2009)) from Keimyung University. Patients with known stroke symptom onset time, baseline CTA, MRI, and with M1-Middle Cerebral Artery (MCA) ± intracranial internal carotid artery (ICA) occlusions were included. Clot length and pial collaterals were measured on baseline CTA. Results: A total of 104 patients (mean age 65.1 ± 12.28 years, 56.7% male, median baseline National Institutes of Health Stroke Scale 13) with intracranial ICA + MCA (n = 50) or isolated M1-MCA (n = 54) occlusions were included. Hyperdense sign on NCCT had a median clot length of 42.3 mm versus 29.5 mm when hyperdense negative (p = 0.02). Clots showing blooming artifact on gradient recall echo MRI had a median length of 39.1 mm versus 24.5 mm without blooming (p = 0.005). Patients with poor baseline collaterals on CTA had longer clots than those with intermediate/good collaterals (median clot length 49.4 mm vs 34.9 mm vs 20.5 mm respectively, p < 0.001). In censored logistic regression modeling, clot length was an independent predictor of hyperdense sign (p = 0.05) and of the presence of blooming artifact (p = 0.006). Conclusions: Clot length and baseline collateral status are independent predictors of clot hyperdensity on NCCT and blooming artifact on gradient recall echo. Longer clots are more likely to be hyperdense and to bloom more, probably because portions of these clots are freshly formed locally due to of stasis of blood around the original clot. This stasis could be because of poor collaterals and inefficient angio-architecture within the cerebral arterial tree.RÉSUMÉ: Les caractéristiques du thrombus sont associées aux collatérales et à l'architecture vasculaire dans l'accident vasculaire cérébral aigu. Contexte: Nous avons émis l'hypothèse que les caillots avec stase sont plus longs. Nous avons donc exploré la relation entre les caractéristiques du caillot, à l'imagerie par tomodensitométrie (CT) sans agent de contraste (CTSAC) et à l'imagerie par résonance magnétique (IRM), et la longueur du caillot et les vaisseaux collatéraux pie-mériens à l'angiographie CT initiale (CTA). Méthode: Cette étude prospective porte sur des patients ayant subi un accident vasculaire cérébral ischémique entre 2005 et 2009 qui ont consulté à l'Université Keinyung. Les patients dont le moment du début des symptômes d'AVC était connu, dont le CTA initial et l'IRM étaient au dossier et qui présentaient une occlusion de l'artère cérébrale moyenne M1 (ACM) ± de la carotide interne intracrânienne (CIIC), ont été inclus dans l'étude. La longueur du caillot et les collatérales pie-mériennes ont été mesurées sur le CTA initial. Résultats: Cent quatre patients...

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“…4 These low-pressure systems include cardiac cul-de-sacs or venous systems. 4,14 In contrast, "white clots" or platelet-rich clots form in highpressure systems, mainly in the arteries.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Thrombus Characteristics Are Related to Collaterals and Angioarchitecture in Acute Stroke

Qazi

Sohn

Mishra

et al. 2015

Can. J. Neurol. Sci.

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“…Because the clot is the primary target of thrombolytic therapy, a clear understanding of the clot characteristics could improve vessel recanalization. In embolic stroke and femoral artery thrombosis, white clots composed of platelets and fibrin with a relative resistance against thrombolysis, whereas erythrocyte-rich clots showed higher response rates [5]. Another crucial consideration is the age of the thrombus.…”

Section: Introductionmentioning

confidence: 99%

Clot dissolution is better with ultrasound assisted thrombolysis for fresh clots with higher cholesterol content

Zhou¹,

Sharma²,

Murugappan³

et al. 2012

AIP Conference Proceedings

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Abstract. Tissue plasminogen activator (tPA) remains the only drug for recanalization in acute ischemic stroke, and the dose is determined by the patient's body-weight. Properties of the blood clot as well as ultrasound exposure might affect the thrombolysis outcome. In this study, clot was prepared by mixing horse blood with CaCl 2 solution and cholesterin up to 1.0 mg/ml. To simulate the aging effect serum was replaced by fresh blood periodically. 225 IU/ml of tPA was used to initiate lysis. Clot was exposed to continuous 2 MHz transcranial Doppler ultrasound at acoustic intensity of 340 mW/cm 2 . The weight of the blood clot increased with its age (from 37.28r2.87 mg at 2 hrs to 51.56r5.34 mg at 10 hrs, p < 0.05). Although no difference between clot-cholesterol levels and thrombolysis with ultrasound or tPA alone was found, combination of these modalities induced significant lysis in the clots with cholesterol levels of more than 0.5 mg/ml (clot-weight reduced by 41.68r2.3%) as compared to clots with normal cholesterol (30.60r4.10%; p < 0.05). Altogether, sonothrombolysis seems to work better in fresh thrombi with highcholesterol levels.

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Stroke

Auer

Meher

2022

Encyclopedia of Life Sciences

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Blood vessels supplying the brain can either be blocked or broken, giving rise to the two kinds of stroke: infarcts and haemorrhages. The symptoms and their permanence depend on how much brain tissue is destroyed and in what location. Key Concepts Stroke is the third leading cause of death. There are two types of strokes: haemorrhagic or ischemic. The occlusive substance in ischemia arises from carotid atherosclerosis or underlying heart disease. ‘Time is Brain’: treating a patient in a timely manner is crucial for preventing increased neuronal loss. tPA is an effective clot‐busting drug, however, it can only be administered within 4.5 h of symptom onset. Endovascular therapy, a mechanical clot‐retrieving technique, is proven to be far more superior to tPA treatment. Brain swelling from oedema occurs secondary to stroke. There are two types of oedema that occurs poststroke, vasogenic or cytotoxic and are known to partly arise from the cerebrospinal fluid in and around the brain. Strokes can lead to severe long‐term motor, sensory and cognitive impairments. Stroke rehabilitation remains essential for relearning skills and regaining functional independence poststroke.

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Visualization of Clot Composition in Ischemic Stroke

Cited by 26 publications

References 12 publications

Thrombus Characteristics Are Related to Collaterals and Angioarchitecture in Acute Stroke

Thrombus Characteristics Are Related to Collaterals and Angioarchitecture in Acute Stroke

Clot dissolution is better with ultrasound assisted thrombolysis for fresh clots with higher cholesterol content

Stroke

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