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Relationship between thrombus attenuation and different stroke subtypes

  • Diagnostic Neuroradiology
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Abstract

Introduction

More insights in the etiopathogenesis of thrombi could be helpful in the treatment of patients with acute ischemic stroke. The aim of our study was to determine the relationship between presence of a hyperdense vessel sign and thrombus density with different stroke subtypes.

Methods

We included 123 patients with acute ischemic anterior circulation stroke and a visible occlusion on CT-angiography caused by cardioembolism (n = 53), large artery atherosclerosis (n = 55), or dissection (n = 15). Presence or absence of a hyperdense vessel sign was assessed and thrombus density was measured in Hounsfield Units (HU) on non-contrast 1 mm thin slices CT. Subsequently, occurrence of hyperdense vessel sign and thrombus density (absolute HU and rHU (=HU thrombus/HU contralateral)) were related with stroke subtypes.

Results

The presence of hyperdense vessel signs differed significantly among subtypes and was found in 45, 64 and 93 % of patients with cardioembolism, large artery atherosclerosis and dissection, respectively (p = 0.003). The mean HU and rHU (+95 % CI) of the thrombi in all vessels were respectively 56.1 (53.2–59.0) and 1.39 (1.33–1.45) in cardioembolism, 64.6 (62.2–66.9) and 1.59 (1.54–1.64) in large artery atherosclerosis and 76.4 (73.0–79.8) and 1.88 (1.79–1.97) in dissection (p < 0.0001). We found the same significant ranking order in the density of thrombi with hyperdense vessel signs (mean HU and rHU (+95 % CI), respectively): cardioembolism 61.3 (57.4–65.3) and 1.49 (57.4–65.3); large artery atherosclerosis 67.3 (64.9–69.7) and 1.65 (1.58–1.71); dissection 76.4 (72.6–80.1) and 1.89 (1.79–1.99, p < 0.0001).

Conclusion

Presence of a hyperdense vessel sign and thrombus density are related to stroke subtype.

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Conflict of interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP 01.132, 3584, CX, Utrecht, The Netherlands

    J. M. Niesten, I. C. van der Schaaf, A. E. van Otterloo, T. van Seeters, A. D. Horsch, W. P. T. M. Mali & B. K. Velthuis

  2. Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands

    G. J. Biessels, M. J. A. Luitse & L. J. Kappelle

  3. Department of Radiology, Rijnstate Hospital Arnhem, Arnhem, The Netherlands

    A. D. Horsch

  4. Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands

    Y. van der Graaf

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  1. J. M. Niesten
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  2. I. C. van der Schaaf
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  3. G. J. Biessels
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  4. A. E. van Otterloo
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  6. A. D. Horsch
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  8. Y. van der Graaf
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  11. B. K. Velthuis
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Consortia

On behalf of the DUtch acute Stroke Trial (DUST)

Corresponding author

Correspondence to J. M. Niesten.

Additional information

The following individuals and institutions constitute the DUST Study University Medical Center Utrecht, The Netherlands Department of Radiology B.K. Velthuis, T. van Seeters, I.C. van der Schaaf, J.M. Niesten, J.W. Dankbaar, W.P.T.M. Mali; Department of Neurology M.J.A. Luitse, G.J. Biessels, L.J. Kappelle; Julius Center for Health Sciences and Primary Care Y. van der Graaf; Academic Medical Center Amsterdam, The Netherlands Department of Radiology C.B.L.M. Majoie, L.F.M. Beenen; Department of Neurology Y.B. Roos; Catharina Hospital Eindhoven, The Netherlands Department of Radiology L.E.M. Duijm; Department of Neurology K. Keizer; Erasmus Medical Center Rotterdam, The Netherlands Department of Radiology A. van der Lugt; Department of Neurology D.W.J. Dippel; Gelre Hospital Apeldoorn, The Netherlands Department of Radiology K.E. Droogh-de Greeve; Department of Neurology H.P. Bienfait; Leiden University Medical Center, The Netherlands Department of Radiology M.A.A. van Walderveen Department of Neurology M.J.H. Wermer; Medical Center Leeuwarden, The Netherlands Department of Radiology J. Dol; Department of Neurology W.J. Schuiling; Medical Center Haaglanden Den Haag, The Netherlands Department of Radiology G.J. Lycklama à Nijeholt; Department of Neurology J. Boiten; Onze Lieve Vrouwe Gasthuis Amsterdam, The Netherlands Department of Radiology D. Duyndam; Department of Neurology V.I.H. Kwa; Radboud University Nijmegen Medical Center, The Netherlands Department of Radiology A. Meijer; Department of Neurology E.J. van Dijk; Rijnstate Hospital Arnhem, The Netherlands Department of Radiology F.O.H.W. Kesselring, A.D. Horsch; Department of Neurology J. Hofmeijer; St. Antonius Hospital Nieuwegein, The Netherlands Department of Radiology J.A. Vos; Department of Neurology W.J. Schonewille; St. Elisabeth Hospital Tilburg, The Netherlands Department of Radiology W.J. van Rooij; Department of Neurology P.L.M. de Kort; St. Franciscus Hospital Rotterdam, The Netherlands; Department of Radiology C.C. Pleiter; Department of Neurology S.L.M. Bakker; VU Medical Center Amsterdam, The Netherlands Department of Radiology J. Bot; Department of Neurology M.C. Visser

Clinical Trial Registration Information URL: http://www.ClinicalTrials.gov.Unique-identifierNCT00880113

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Niesten, J.M., van der Schaaf, I.C., Biessels, G.J. et al. Relationship between thrombus attenuation and different stroke subtypes. Neuroradiology 55, 1071–1079 (2013). https://doi.org/10.1007/s00234-013-1217-y

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