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Ischemic stroke
Original research
Prevalence of intracerebral thrombus detected by optical coherence tomography in patients with posterior circulation stroke or transient ischemic attack
  1. Ran Xu1,2,
  2. Bin Yang1,2,
  3. Tao Wang1,2,
  4. Xiao Zhang1,2,
  5. Tianhua Li1,2,
  6. Yao Feng1,2,
  7. Xiaofan Guo3,
  8. Jinzhu Jia4,
  9. Yan Ma1,2,
  10. Adam A Dmytriw5,6,
  11. Haibo Jia7,
  12. Liqun Jiao1,2,8,9
    1. 1Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, People's Republic of China
    2. 2China International Neuroscience Institute (China-INI), Beijing, People's Republic of China
    3. 3Department of Neurology, Loma Linda University Health, Loma Linda, California, USA
    4. 4School of Public Health and Center for Statistical Science, Peking University, Beijing, People's Republic of China
    5. 5Neuroendovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
    6. 6Neuroradiology and Neurointervention, Brigham and Women's Hospital, Boston, Massachusetts, USA
    7. 7Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
    8. 8Department of Interventional Neuroradiology, Xuanwu Hospital Capital Medical University, Beijing, People's Republic of China
    9. 9Daepartment of Neurosurgery and Neurology, Jinan Hospital of Xuanwu Hospital, Shandong First Medical University, Jinan, People's Republic of China
    1. Correspondence to Dr Liqun Jiao; liqunjiao{at}sina.cn; Professor Haibo Jia; jhb101180{at}163.com

    Abstract

    Background The incidence of thrombosis in patients with intracranial atherosclerotic stenosis (ICAS) remains unclear. Optical coherence tomography (OCT) has the potential to explore the vessel wall structure of posterior-circulation ICAS because of its relatively straight anatomical structure compared with that of the anterior cerebral arteries. This study aimed to determine the prevalence and characteristics of thrombosis in the posterior-circulation ICAS using OCT.

    Methods This prospective study was conducted on 135 patients with posterior-circulation arterial stenosis who underwent OCT. All patients were symptomatic and had a severely stenotic lesion (70–99%) in the vetebrobasilar artery. The enrolled patients were classified according to the presence of in situ thrombus as defined by OCT. Clinical data and OCT characteristics were compared.

    Results Eighty-two patients diagnosed with posterior-circulation ICAS were enrolled. In situ thrombi were identified in 34 patients. Clinically, patients with in situ thrombus were more prone to cerebral infarctions than transient ischemic attacks. The percentage area of stenosis in the non-thrombus group was significantly lower than that in the thrombus group. The thrombus burden, mean flow area, mean thrombus area, maximum lipid arc, and mean lumen area were significantly different among white, red, and mixed thrombi.

    Conclusions We achieved in vivo vessel wall structural analysis of posterior-circulation ICAS with the largest sample size. We also revealed the true incidence of in situ thrombosis and potential corresponding clinical events of posterior-circulation ICAS for the first time.

    • Atherosclerosis
    • Stenosis
    • Stroke
    • Vessel Wall

    Data availability statement

    Data are available upon reasonable request.

    https://doi.org/10.1136/jnis-2024-022002

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      Data availability statement

      Data are available upon reasonable request.

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      Footnotes

      • X @AdamDmytriw

      • RX and BY contributed equally.

      • Contributors Guarantor: LJ. Study conception and design: RX, BY, HJ, LJ. Development of methodology: TW, TL, YF, AAD, XG. Acquisition of data: RX, BY, YM. Analysis and interpretation of data: JJ, XZ. Study supervision: HJ, LJ. All authors were involved in writing the manuscript.

      • 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.