Stroke Etiology and Thrombus Computed Tomography Characteristics in Patients With Acute Ischemic Stroke
Authors: Boodt Nikki , Compagne Kars C.J. , Dutra Bruna G. , Samuels Noor , Tolhuisen Manon L. , Alves Heitor C.B.R. , Kappelhof Manon , Lycklama à Nijeholt Geert J. , Marquering Henk. A. , Majoie Charles B.L.M. , Lingsma Hester F. , Dippel Diederik W.J. , van der Lugt Aad ,   on behalf of the MR CLEAN Registry Investigators, Roos Yvo , van Oostenbrugge Robert , van Zwam Wim , Boiten Jelis , Vos Jan Albert , Jansen Ivo , Mulder Maxim , Goldhoorn Robert-Jan , Schonewille Wouter , Vos Jan Albert , Coutinho Jonathan , Wermer Marieke , van Walderveen Marianne , Staals Julie , van Zwam Wim , Hofmeijer Jeannette , Martens Jasper , Boiten Jelis , Roozenbeek Bob , Emmer Bart , de Bruijn Sebastiaan , van Dijk Lukas , van der Worp H. Bart , Lo Rob , van Dijk Ewoud , Boogaarts Hieronymus , de Kort Paul , van Tuijl Julia , Peluso Jo , van den Berg Jan , van Hasselt Boudewijn , Aerden Leo , Dallinga René , Uyttenboogaart Maarten , Eshghi Omid , Bokkers Reinoud , Schreuder Tobien , Heijboer Roel , Keizer Koos , Yo Lonneke , den Hertog Heleen , Sturm Emiel , van Zwam Wim , van Walderveen Marianne , Sprengers Marieke , Jenniskens Sjoerd , van den Berg René , Yoo Albert , Beenen Ludo , Postma Alida , Roosendaal Stefan , van der Kallen Bas , van den Wijngaard Ido , van Es Adriaan , Emmer Bart , Martens Jasper , Yo Lonneke , Vos Jan Albert , Bot Joost , van Doormaal Pieter-Jan , Roos Yvo , van Oostenbrugge Robert , van Zwam Wim , Boiten Jelis , Vos Jan Albert , Schonewille Wouter , Hofmeijer Jeannette , van der Worp Bart , Lo Rob , van Oostenbrugge Robert , Hofmeijer Jeannette , Flach Zwenneke , el Ghannouti Naziha , Sterrenberg Martin , Puppels Corina , Pellikaan Wilma , Sprengers Rita , Elfrink Marjan , de Meris Joke , Vermeulen Tamara , Geerlings Annet , van Vemde Gina , Simons Tiny , van Rijswijk Cathelijn , Bongenaar Hester , Bodde Karin , Kleijn Sandra , Lodico Jasmijn , Droste Hanneke , Wollaert M , Jeurrissen D , Bos Ernas , Drabbe Yvonne , Zweedijk Berber , Khalilzada Mostafa , Venema Esmee , Chalos Vicky , Geuskens Ralph , van Straaten Tim , Ergezen Saliha , Harmsma Roger , Muijres Daan , de Jong Anouk , Hinseveld Wouter , Berkhemer Olvert , Boers Anna , Huguet J. , Groot P. , Mens Marieke , van Kranendonk Katinka , Treurniet Kilian , Tolhuijsen Manon 
Published: May 2020

Background and Purpose—
If a relationship between stroke etiology and thrombus computed tomography characteristics exists, assessing these characteristics in clinical practice could serve as a useful additional diagnostic tool for the identification of stroke subtype. Our purpose was to study the association of stroke etiology and thrombus computed tomography characteristics in patients with acute ischemic stroke due to a large vessel occlusion.

Methods—
For 1429 consecutive patients enrolled in the MR CLEAN Registry, we determined stroke cause as defined by the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria. The association of stroke etiology with the hyperdense artery sign, clot burden score, and thrombus location was estimated with univariable and multivariable binary and ordinal logistic regression. Additionally, for 367 patients with available thin-section imaging, we assessed the association of stroke etiology with absolute and relative thrombus attenuation, distance from internal carotid artery-terminus to thrombus, thrombus length, and thrombus attenuation increase with univariable and multivariable linear regression.

Results—
Compared with cardioembolic strokes, noncardioembolic strokes were associated with presence of hyperdense artery sign (odds ratio, 2.2 [95% CI, 1.6–3.0]), lower clot burden score (common odds ratio, 0.4 [95% CI, 0.3–0.6]), shift towards a more proximal thrombus location (common odds ratio, 0.2 [95% CI, 0.2–0.3]), higher absolute thrombus attenuation (β, 3.6 [95% CI, 0.9–6.4]), decrease in distance from the ICA-terminus (β, −5.7 [95% CI, −8.3 to −3.0]), and longer thrombi (β, 8.6 [95% CI, 6.5−10.7]), based on univariable analysis. Thrombus characteristics of strokes with undetermined cause were similar to those of cardioembolic strokes.

Conclusions—
Thrombus computed tomography characteristics of cardioembolic stroke are distinct from those of noncardioembolic stroke. Additionally, our study supports the general hypothesis that many cryptogenic strokes have a cardioembolic cause. Further research should focus on the use of thrombus computed tomography characteristics as a diagnostic tool for stroke cause in clinical practice.