Background The mechanisms underlying large-vessel occlusion strokes (LVOS) caused by intracranial atherosclerosis (ICAS) remain incompletely understood. This study aimed to characterize the distinct features of ICAS-LVOS to elucidate its pathological basis. Methods We conducted a cross-sectional analysis of a prospective, single-center cohort of acute ischemic stroke patients (January 2017 to January 2023). Participants were classified into three groups: ICAS-LVOS, atrial fibrillation-related LVOS (AF-LVOS), and symptomatic ICAS without LVOS (sICAS). Clinical and laboratory data were compared. Results The study included 279 patients, comprising 70 ICAS-LVOS patients, 78 AF-LVOS patients, and 131 sICAS patients. Compared to AF-LVOS, ICAS-LVOS patients demonstrated associations with younger age (OR: 0.898; p = 0.007), previous stroke (OR: 6.672; p = 0.031), posterior circulation involvement (OR: 30.299; p = 0.011) and higher fibrinogen levels (OR: 3.421; p = 0.006). A ratio of fibrinogen/D-dimer ≥6 effectively identified ICAS-LVOS with high specificity. Relative to sICAS, ICAS-LVOS was associated with higher body mass index (OR: 1.176; p = 0.002), white blood cell counts (OR: 1.234; p = 0.002), and fibrinogen levels (OR: 1.600; p = 0.029). Within the ICAS-LVOS group, higher thrombus burden was correlated with hypertension (OR: 6.071; p = 0.029) and higher fibrinogen levels (OR: 2.322; p = 0.046). Notably, in patients with fibrinogen levels 3.2 g/L, intravenous thrombolysis was associated with fewer passes of thrombectomy devices. Conclusion ICAS-LVOS exhibits a unique profile distinct from AF-LVOS and sICAS. Fibrinogen appears to play a significant role in thrombogenesis and the occurrence of LVOS in ICAS, influencing thrombus characteristics and potentially modifying the efficacy of thrombolysis in specific patient subgroups.
Liu et al. (Wed,) studied this question.