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Original research
CT hyperdense cerebral artery sign reflects distinct proteomic composition in acute ischemic stroke thrombus
  1. Derrek Schartz1,2,
  2. Sajal Medha K Akkipeddi2,
  3. Siddharth Chittaranjan2,
  4. Redi Rahmani2,
  5. Aditya Gunturi2,
  6. Nathaniel Ellens2,
  7. Gurkirat Singh Kohli2,
  8. Alex Kessler1,
  9. Thomas Mattingly2,
  10. Craig Morrell3,
  11. Tarun Bhalla2,
  12. Matthew T Bender2
  1. 1 Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA
  2. 2 Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
  3. 3 Aab Cardiovascular Research Institute, University of Rochester Medical Center, Rochester, New York, USA
  1. Correspondence to Dr Derrek Schartz, Imaging Sciences, University of Rochester Medical Center, Rochester, NY 14642, USA; derrek_schartz{at}


Background Hyperdense cerebral artery sign (HCAS) is an imaging biomarker in acute ischemic stroke (AIS) that has been shown to be associated with various clinical outcomes and stroke etiology. While prior studies have correlated HCAS with histopathological composition of cerebral thrombus, it is unknown whether and to what extent HCAS is also associated with distinct clot protein composition.

Methods Thromboembolic material from 24 patients with AIS were retrieved via mechanical thrombectomy and evaluated with mass spectrometry in order to characterize their proteomic composition. Presence (+) or absence (−) of HCAS on preintervention non-contrast head CT was then determined and correlated with thrombus protein signature with abundance of individual proteins calculated as a function HCAS status.

Results 24 clots with 1797 distinct proteins in total were identified. 14 patients were HCAS(+) and 10 were HCAS(−). HCAS(+) were most significantly differentially abundant in actin cytoskeletal protein (P=0.002, Z=2.82), bleomycin hydrolase (P=0.007, Z=2.44), arachidonate 12-lipoxygenase (P=0.004, Z=2.60), and lysophospholipase D (P=0.007, Z=2.44), among other proteins; HCAS(−) clots were differentially enriched in soluble N-ethylmaleimide-sensitive factor (NSF) attachment protein (P=0.0009, Z=3.11), tyrosine-protein kinase Fyn (P=0.002, Z=2.84), and several complement proteins (P<0.05, Z>1.71 for all), among numerous other proteins. Additionally, HCAS(−) thrombi were enriched in biological processes involved with plasma lipoprotein and protein-lipid remodeling/assembling, and lipoprotein metabolic processes (P<0.001), as well as cellular components including mitochondria (P<0.001).

Conclusions HCAS is reflective of distinct proteomic composition in AIS thrombus. These findings suggest that imaging can be used to identify mechanisms of clot formation or maintenance at the protein level, and might inform future research on thrombus biology and imaging characterization.

  • CT
  • thrombectomy
  • CT angiography
  • stroke

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors Conception and design: DS, SMKA, MTB. Data acquisition: DS, SMKA, RR, AG, NE, GSK, AK, MTB. Data analysis: DS, SMKA, SC. Interpretation of data: all authors. Primary manuscript writing: DS, SMKA, AK, MTB. Manuscript editing and appraisal: all authors. DS and MTB are guarantors.

  • Funding Funding was provided by the Department of Neurosurgery of the University of Rochester Medical Center.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.