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Abstract
Background and Objectives New imaging techniques have advanced our ability to capture thrombus characteristics and burden in real time. An improved understanding of recanalization rates with thrombolysis and endovascular thrombectomy based on thrombus characteristics has spurred interest in new therapies for acute stroke.
Methods and Results This article reviews the biochemical, structural, and imaging characteristics of intracranial thrombi in acute ischemic stroke; the relationship between thrombus composition and response to lytic and endovascular therapies; and current and future directions for improving outcomes in patients with acute stroke based on thrombus characteristics.
Discussion Thrombus composition, size, location, and timing from stroke onset correlate with imaging findings in acute ischemic stroke and are associated with clinical outcome. Further research across multiple domains could assist in better applying our knowledge of thrombi to patient selection and individualization of acute therapies.
Glossary
- CBS=
- clot burden score;
- CTA=
- CT angiography;
- EVT=
- endovascular thrombectomy;
- HAS=
- hyperdense artery sign;
- HU=
- Hounsfield Unit;
- ICA=
- internal carotid artery;
- MCA=
- middle cerebral artery;
- MRA=
- magnetic resonance angiography;
- mRS=
- modified Rankin Scale;
- NAC=
- N-acetylcysteine;
- NCCT=
- noncontrast CT;
- NIHSS=
- NIH Stroke Scale;
- PN-1=
- protease nexin 1;
- RBC=
- red blood cell;
- SVS=
- susceptibility vessel sign;
- SWI=
- susceptibility-weighted imaging;
- TNK=
- tenecteplase;
- tPA=
- tissue plasminogen activator;
- vWF=
- von Willebrand factor
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- © 2021 American Academy of Neurology
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- Abstract
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- Disclosure
- Appendix Authors
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- Info & Disclosures
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