Visualization of Clot Composition in Ischemic Stroke

Abstract

See related article, page 1237–1243 Sudden occlusion of a brain artery by a blood clot represents the pivotal event in ischemic stroke. Consequently, most of the therapeutic effort during the acute stage of cerebral ischemia aims at resolving the thrombus to restore blood flow. Because the clot is the primary target of thrombolytic therapy, the definition of clot characteristics that are associated with successful vessel recanalization could help to identify patients at risk and stratify treatment decisions. One promising approach is to visualize the thrombotic vessel by noninvasive imaging techniques. Indeed, early vessel signs indicative for occlusive clots have been described in ischemic stroke such as the hyperdense middle cerebral artery sign (HMCAS) on CT or blooming artifact (BA) on specific MRI sequences and their presence was shown to be associated with lower recanalization rates and worse outcomes.1,2 However, little is known about the histological basis, that is, clot composition, underlying the occurrence of these surrogate markers. The interesting question …