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

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.

Endovascular Treatment of Acute Stroke: Evolution and Selection of Techniques and Instruments Based on Thrombus Imaging

“…This is in accordance with a recent study demonstrating that the presence of multiple thrombi before initiation of thrombolytic therapy predicted worse outcome [30].…”

Order of Treatment Matters in Ischemic Stroke: Mechanical Thrombectomy First, Then Carotid Artery Stenting for Tandem Lesions of the Anterior Circulation

“…This is due to interactions between stent retriever and stent struts in cases where the guiding catheter could not be advanced through the carotid stent, which prevents the use of these techniques. Another argument could be that restoration of blood flow after primary CAS led to an increased pressure on the intracranial thrombus, which may result in clot fragmentation distally into the territory as this is known to be associated with a worse outcome [27]. This might be an explanation for the low potential of rehabilitation in our patients first treated with CAS.…”

Time to redefine success? TICI 3 versus TICI 2b recanalization in middle cerebral artery occlusion treated with thrombectomy

“…It has been demonstrated, based on preinterventional susceptibility-weighted MRI, that occlusions in LVO strokes are typically unilocular in >90% of patients— that is, without additional involvement of distal branches 21. This implies that most distal branch occlusions seen after MTE are due to thrombus fragmentation and distal embolization that occurs in the course of the endovascular procedure.…”