A Study on Radiological Characteristics of Thrombus in Cardioembolic and Large Artery Atherosclerotic Ischemic Strokes

Background and Aims Various radiological parameters reflect thrombus characteristics in acute ischemic stroke (AIS). Although numerous studies on thrombus characteristics in AIS have been conducted, none have been reported from India. Therefore, we aimed to compare thrombus permeability and burden between AIS from large-artery atherosclerosis (LAA) and cardioembolism (CE) and to assess their association with outcomes. Materials and Methods This prospective, exploratory, longitudinal study enrolled consecutive patients with LAA and CE over 1 year. Patients with thrombotic occlusion were included in the analysis of thrombus indices. Non-contrast computed tomography (NCCT) and CT angiography (CTA) were used to measure thrombus attenuation, thrombus attenuation index (TAI), clot length, clot burden score (CBS), and basilar artery on computed tomography angiography (BATMAN) score. Multivariate analyzes evaluated whether these thrombus indices were associated with the 90-day modified Rankin scale (mRS). Results Of the 305 AIS patients screened, CE and LAA comprised 10.5% (32) and 42.6% (130), respectively. Of these, 89 patients underwent CTA, 43 LAA patients, and 5 CE patients exhibited thrombotic occlusion. TAI values were lower in the CE group compared to the LAA group (8.60 ± 1.49 vs. 14.60 ± 10.96; P = .281). Clot length (cm) was significantly longer in LAA (1.9 vs. 0.7 cm, P = .014), while TAI and CBS did not differ. None of these indices was independently associated with poor 90-day mRS. Conclusion TAI and clot burden did not differ significantly between the LAA and CE. Clot length was longer in the LAA. None of the thrombus indices were associated with functional outcomes.