Background The underlying etiology of intracranial non-occlusive intraluminal thrombus (iNOT) remains unknown. This study aimed to investigate whether the presence of iNOT can indicate the underlying etiology of large vessel occlusion (LVO) in patients undergoing endovascular therapy (EVT).
Methods Among patients who underwent EVT at three comprehensive stroke centers, we included those with intracranial LVO in the anterior circulation. The presence of iNOT was determined by pretreatment DSA. We investigated the association between iNOT and intracranial atherosclerotic stenosis (ICAS) related LVO.
Results Of 546 patients, 44 (8.1%) had iNOT. Patients with iNOT were younger, had less hypertension, atrial fibrillation, and a history of antiplatelet use. In addition, the involvement of the M1 segment of the middle cerebral artery (MCA) was more frequent. However, they had a lower National Institutes of Health Stroke Scale (NIHSS) score on admission and longer onset to recanalization time compared with patients with no iNOT. In a logistic regression model adjusting for age, sex, atrial fibrillation, smoking, prior antiplatelet and anticoagulant use, intravenous tissue plasminogen activator, NIHSS on admission, number of technical trials, intraprocedural re-occlusion, and the location of LVO (p<0.10 in the univariate analysis), the presence of iNOT was significantly associated with ICAS related LVO (adjusted OR 3.04; 95% CI 1.33 to 6.90; p=0.007).
Conclusions The presence of iNOT may reflect an underlying ICAS related LVO in patients undergoing EVT.
Data availability statement
Data are available upon reasonable request.
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Contributors SHJ: study design, data collection, data analysis, data interpretation, preparation of manuscript review, and editing. HP: study design, data collection, data analysis, data interpretation, preparation of manuscript review, and editing. JY: data collection, imaging analysis, review, and editing. J-HH, JSL, S-JL, Y-WK, JMH, JWC, D-HK, Y-SK, Y-HH, and S-IS: data collection, review, and editing.
Funding This work was supported by a National Research Foundation of Korea grant funded by the Korean government (MSIT) (18 No 2020R1G1A007100).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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