Stroke Etiology and Thrombus Computed Tomography Characteristics in Patients With Acute Ischemic Stroke
Nikki Boodt, Kars C.J. Compagne, Bruna Garbugio Dutra, Noor Samuels, Manon L. Tolhuisen, Heitor Alves, Manon Kappelhof, Geert J. Lycklama à Nijeholt, Henk A. Marquering, Charles B.L.M. Majoie, Hester F. Lingsma, Diederik W.J. Dippel, Aad van der Lugt, on behalf of the MR CLEAN Registry Investigators, Yvo Roos, Robert van Oostenbrugge, Wim H. van Zwam, Jelis Boiten, Jan Albert Vos, Ivo G.H. Jansen, Maxim J.H.L. Mulder, Robert-Jan Goldhoorn, Wouter Schonewille, Jan Albert Vos, Jonathan M. Coutinho, Marieke J.H. Wermer, Marianne van Walderveen, Julie Staals, Wim H. van Zwam, Jeannette Hofmeijer, Jasper M. Martens, Jelis Boiten, Bob Roozenbeek, Bart J. Emmer, Sebastiaan F. de Bruijn, Lukas van Dijk, H. Bart van der Worp, Rob Lo, Ewoud van Dijk, Hieronymus D. Boogaarts, Paul de Kort, Julia van Tuijl, Jo P. Peluso, Jan Berg, Boudewijn van Hasselt, Leo A.M. Aerden, René J. Dallinga, Maarten Uyttenboogaart, Omid Eshghi, Reinoud P.H. Bokkers, Tobien H.C.M.L. Schreuder, Roel J.J. Heijboer, Koos Keizer, Lonneke S.F. Yo, Heleen den Hertog, Emiel J.C. Sturm, Wim H. van Zwam, Marianne van Walderveen, Marieke E.S. Sprengers, Sjoerd F.M. Jenniskens, René van den Berg, Albert J. Yoo, Ludo F.M. Beenen, Alida A. Postma, Stefan D. Roosendaal, Bas van der Kallen, Ido R. van den Wijngaard, Adriaan C.G.M. van Es, Bart J. Emmer, Jasper M. Martens, Lonneke S.F. Yo, Jan Albert Vos, Joost Bot, Pieter‐Jan van Doormaal, Yvo Roos, Robert van Oostenbrugge, Wim H. van Zwam, Jelis Boiten, Jan Albert Vos, Wouter Schonewille, Jeannette Hofmeijer, H. Bart van der Worp, Rob Lo, Robert van Oostenbrugge, Jeannette Hofmeijer, Zwenneke Flach, Naziha el Ghannouti, Martin Sterrenberg, Corina Puppels, Wilma Pellikaan, Rita Sprengers, Marjan Elfrink, Joke de Meris, Tamara Vermeulen, Annet Geerlings, Gina van Vemde, Tiny Simons, Cathelijn van Rijswijk, Hester Bongenaar, Karin Bodde
Abstract
Background and Purpose- If a relationship between stroke etiology and thrombus computed tomography characteristics exists, assessing these characteristics in clinical practice could serve as a useful additional diagnostic tool for the identification of stroke subtype. Our purpose was to study the association of stroke etiology and thrombus computed tomography characteristics in patients with acute ischemic stroke due to a large vessel occlusion. Methods- For 1429 consecutive patients enrolled in the MR CLEAN Registry, we determined stroke cause as defined by the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria. The association of stroke etiology with the hyperdense artery sign, clot burden score, and thrombus location was estimated with univariable and multivariable binary and ordinal logistic regression. Additionally, for 367 patients with available thin-section imaging, we assessed the association of stroke etiology with absolute and relative thrombus attenuation, distance from internal carotid artery-terminus to thrombus, thrombus length, and thrombus attenuation increase with univariable and multivariable linear regression. Results- Compared with cardioembolic strokes, noncardioembolic strokes were associated with presence of hyperdense artery sign (odds ratio, 2.2 [95% CI, 1.6-3.0]), lower clot burden score (common odds ratio, 0.4 [95% CI, 0.3-0.6]), shift towards a more proximal thrombus location (common odds ratio, 0.2 [95% CI, 0.2-0.3]), higher absolute thrombus attenuation (β, 3.6 [95% CI, 0.9-6.4]), decrease in distance from the ICA-terminus (β, -5.7 [95% CI, -8.3 to -3.0]), and longer thrombi (β, 8.6 [95% CI, 6.5-10.7]), based on univariable analysis. Thrombus characteristics of strokes with undetermined cause were similar to those of cardioembolic strokes. Conclusions- Thrombus computed tomography characteristics of cardioembolic stroke are distinct from those of noncardioembolic stroke. Additionally, our study supports the general hypothesis that many cryptogenic strokes have a cardioembolic cause. Further research should focus on the use of thrombus computed tomography characteristics as a diagnostic tool for stroke cause in clinical practice.