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ORIGINAL RESEARCH article

Front. Neurol.
Sec. Stroke
Volume 15 - 2024 | doi: 10.3389/fneur.2024.1395764
This article is part of the Research Topic Advances and controversies in ischemic stroke management: from prevention to diagnosis and acute treatment View all 72 articles

The clot pattern determined by DSA and CTA can predicting intracranial atherosclerotic stenosis in acute ischemic stroke patients

Provisionally accepted
Jichuan Li Jichuan Li 1Jianhong Yang Jianhong Yang 1Xiang Gao Xiang Gao 2Qing Han Qing Han 1Yuefei Wu Yuefei Wu 1Qing Shang Qing Shang 1Yueshi Huang Yueshi Huang 1Yao Xu Yao Xu 1Yi Huang Yi Huang 2Longting Lin Longting Lin 3*
  • 1 department of neurology, the first affiliated hospital of ningbo university, Ningbo, Zhejiang Province, China
  • 2 Department of Neurosurgery, The First Affiliated Hospital of Ningbo University, Ningbo, China
  • 3 Sydney Brain Center, University of New South Wales, New South Wales, Australia

The final, formatted version of the article will be published soon.

    Background: This study examines whether clot pattern at large artery occlusion sites, as seen on digital subtraction angiography (DSA) and computed tomography angiography (CTA), is a reliable indicator of intracranial atherosclerotic stenosis (ICAS) in acute ischemic stroke patients.We retrospectively analyzed data from patients treated with stent retriever thrombectomy for intracranial occlusions at our institute since 2017. Follow-up was conducted at 3 months. Patients were grouped based on initial angiography clot topographies (cut-off or tapered signs). We evaluated these topographies' potential in predicting ICAS, including a clinical outcomes analysis using clot pattern, age, toast classified and onset-to-door time.Results: Among 131 patients (mean age 66.6 years), clot pattern was a significant ICAS predictor. The DSA-based model had a predictive area under the curve (AUC) of 0.745, with 55.1% sensitivity and 94.0% specificity. A multivariate model including age, onset-to-door time, toast classified as LAA and tapered sign had an AUC of 0.916. In patients over 65 with onset-to-door time >5 hours and a tapered sign, the AUC reached 0.897. The predictive ability of the tapered sign was similar in DSA and CTA, showing 73.4% agreement between modalities. 2 Conclusion: Tapered sign clot pattern on DSA is significantly associated with ICAS.Incorporating this with age, toast classified as LAA and onset-to-door time enhances ICAS prediction. CTA clot pattern is also a reliable predictor, underscoring the importance of clot pattern in ICAS identification.

    Keywords: Clot pattern, Intracranial atherosclerotic stenosis, Stroke, Digital subtraction angiography, computed tomography angiography, Residual stenosis

    Received: 04 Mar 2024; Accepted: 28 Jun 2024.

    Copyright: © 2024 Li, Yang, Gao, Han, Wu, Shang, Huang, Xu, Huang and Lin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Longting Lin, Sydney Brain Center, University of New South Wales, New South Wales, 2050, Australia

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