Intracranial non-occlusive intraluminal thrombus may indicate underlying etiology of large vessel occlusion in patients undergoing endovascular therapy

• Published in: Journal of neurointerventional surgery Vol. 14; no. 10; pp. 997 - 1001
• Main Authors: Jang, Seong Hwa, Park, Hyungjong, Yoo, Joonsang, Hong, Jeong-Ho, Lee, Jin Soo, Lee, Seong-Joon, Kim, Yong-Won, Hong, Ji Man, Choi, Jin Wook, Kang, Dong-Hun, Kim, Yong-Sun, Hwang, Yang-Ha, Sohn, Sung-Il
• Format: Journal Article
• Language: English
• Published: BMA House, Tavistock Square, London, WC1H 9JR BMJ Publishing Group Ltd 01.10.2022; BMJ Publishing Group LTD
• Subjects: Atherosclerosis; Blood clots; Cardiac arrhythmia; Etiology; Ischemic stroke; stroke; thrombectomy; South Korea
• ISSN: 1759-8478; 1759-8486
• DOI: 10.1136/neurintsurg-2021-017995

BackgroundThe underlying etiology of intracranial non-occlusive intraluminal thrombus (iNOT) remains unknown. This study aimed to investigate whether the presence of iNOT can indicate the underlying etiology of large vessel occlusion (LVO) in patients undergoing endovascular therapy (EVT).MethodsAmong patients who underwent EVT at three comprehensive stroke centers, we included those with intracranial LVO in the anterior circulation. The presence of iNOT was determined by pretreatment DSA. We investigated the association between iNOT and intracranial atherosclerotic stenosis (ICAS) related LVO.ResultsOf 546 patients, 44 (8.1%) had iNOT. Patients with iNOT were younger, had less hypertension, atrial fibrillation, and a history of antiplatelet use. In addition, the involvement of the M1 segment of the middle cerebral artery (MCA) was more frequent. However, they had a lower National Institutes of Health Stroke Scale (NIHSS) score on admission and longer onset to recanalization time compared with patients with no iNOT. In a logistic regression model adjusting for age, sex, atrial fibrillation, smoking, prior antiplatelet and anticoagulant use, intravenous tissue plasminogen activator, NIHSS on admission, number of technical trials, intraprocedural re-occlusion, and the location of LVO (p<0.10 in the univariate analysis), the presence of iNOT was significantly associated with ICAS related LVO (adjusted OR 3.04; 95% CI 1.33 to 6.90; p=0.007).ConclusionsThe presence of iNOT may reflect an underlying ICAS related LVO in patients undergoing EVT.