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Review
. 2015 Apr;10(3):298-305.
doi: 10.1111/ijs.12435. Epub 2014 Dec 25.

Imaging of occlusive thrombi in acute ischemic stroke

Gregory G Gasparian  1 , Nerses Sanossian, Mark S Shiroishi, David S Liebeskind
Affiliations
Review

Imaging of occlusive thrombi in acute ischemic stroke

Gregory G Gasparian et al. Int J Stroke. 2015 Apr.

Abstract

Thrombi, or clots, often occlude proximal segments of the cerebral arterial circulation in acute ischemic stroke. Thromboembolic occlusion or thrombi superimposed on atherosclerotic plaque are the principal focus of acute stroke therapies such as thrombolysis or thrombectomy. We review the imaging characteristics of thrombi on multimodal computed tomography and magnetic resonance imaging, angiography, and ultrasonography, summarizing recent studies that facilitate therapeutic decision-making from these noninvasive studies. Information about the location, size, and imaging characteristics can be ascertained using these techniques. Imaging findings in relation to occlusive thrombus have been correlated with clot pathology, response to therapeutic interventions, and clinical outcome. Diagnostic evaluation of occlusive thrombi on noninvasive studies now constitutes an integral component of acute stroke management.

Keywords: CT; MRI; collaterals; ischemic; stroke; thrombi.

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Figures

Figure 1
Figure 1
Figure A- Hyperdense MCA sign on noncontrast CT Figure B- Demonstration of Clot on CTA with proximal and distal border outlined by contrast
Figure 2
Figure 2
Figures A & B: Grading schemes used for contrast opacification and target lesion demarcation respectively Figure C: Blurred Left MCA contrast opacification Figure D: Sharp Cutoff Lesion in Right MCA Figure E: Tandem Tram Track Lesion
Figure 3
Figure 3
Figure A: Red blood cell-predominant thrombus retrieved from the middle cerebral artery during embolectomy Figure B: Platelet and fibrin-predominant thrombus retrieved from the middle cerebral artery during embolectomy
Figure 4
Figure 4
Gradient recall imaging (A) demonstrates blooming artifact within the right middle cerebral artery (arrow). Sluggish flow proximal to the clot (B) and distal to the clot through leptomeningeal collaterals (C) leads to vascular hyperintensity of Fluid Attenuation Inversion Recovery (FLAIR) sequences.
See this image and copyright information in PMC

References

    1. Grotta J. Timing of Thrombolysis for acute ischemic stroke. Ann N Y Academy of Science. 2012;1268(1):141–4. - PubMed
    1. Srinivasan A, Goyal M, Alazri F, Lum C. State-of-the-art imaging of acute stroke. Radiographics. 2006;26:75–95. - PubMed
    1. Chehab T, Ha T. Acute middle cerebral artery thrombosis. Kansas Journal of Medicine. 2007
    1. Molina C. Futile recanalization in mechanical embolectomy trials: a call to improve selection of patients for revascularization. Stroke. 2010;41(5):842–3. - PubMed
    1. Ozdemir O, Leung A, Bussiére M, Hachinski V, Pelz D. Hyperdense internal carotid artery sign: a CT sign of acute ischemia. Stroke. 2008;39(7):2011–6. - PubMed

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