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Antiplatelet Usage Impacts Clot Density in Acute Anterior Circulation Ischemic Stroke

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ABSTRACT

We explored whether clot density in middle cerebral artery (MCA) occlusion is related to clinical variables, stroke etiology, blood constituents, and prestroke medication. We performed a retrospective chart review of patients with acute ischemic stroke of the anterior circulation admitted to two Central European stroke centers. The acquisition of non-contrast enhanced CT (NECT) and CT angiography (CTA) within 4.5 h of symptom onset was obligatory. We assessed the site of MCA occlusion as well as density, area, and length of the clot in 150 patients. The Hounsfield unit values for the clot were divided with contralateral MCA segment to yield relative Hounsfield Unit ratio (rHU). The site of the vessel occlusion (M1 vs. M2) and antiplatelet usage, but not stroke etiology, significantly influenced rHU. We found an inverse correlation of rHU with erythrocyte count (p < 0.001). The multivariate analysis revealed that a higher rHU (i.e., clot being more hyperdense) was more likely with the use of antiplatelets (OR 4.24, CI 1.10–16.31, p = 0.036). Erythrocyte (OR 0.18, CI 0.05–0.55, p = 0.003), and thrombocyte counts (OR 0.99, CI 0.98–0.99, p = 0.029) were associated with odds for more hypodense clots (lower rHU). Our study disclosed that antiplatelet therapy impacts the composition of intracranial clots of the anterior circulation.

No MeSH data available.


Analysis of relative clot density (rHU) in 150 patients with and without intake of antiplatelets (p = 0.024).
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ijms-17-01382-f001: Analysis of relative clot density (rHU) in 150 patients with and without intake of antiplatelets (p = 0.024).

Mentions: The rHU was significantly lower for a HAS located in the M1 segment compared to a distal occlusion (p = 0.019). rHU was higher in patients on antiplatelets prior to stroke (p = 0.024, Figure 1). In contrast, this could not be shown for the patients receiving anticoagulants (n = 18). This finding was pronounced in the analysis of M2 occlusions (p = 0.021), whereas no impact of prior antiplatelet usage was found in thrombi occluding the M1 segment (p = 0.419). The erythrocyte count was negatively correlated with rHU (p < 0.001, rho = −0.324). We did not identify an association of fibrinogen levels with rHU. The thrombocyte count was negatively related to rHU in the M2 segment only (p = 0.05, rho = −0.626). We did not find differences of rHU by TOAST etiology, or by cardioembolic vs. other etiologies. Area and length of the thrombus did not correlate with the rHU. This finding was corroborated in patients with cardioembolic vs. other etiologies. In a subgroup of patients that underwent mechanical thrombectomy, there was no correlation with length, area, or history of antiplatelets with recanalization.


Antiplatelet Usage Impacts Clot Density in Acute Anterior Circulation Ischemic Stroke
Analysis of relative clot density (rHU) in 150 patients with and without intake of antiplatelets (p = 0.024).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5037662&req=5

ijms-17-01382-f001: Analysis of relative clot density (rHU) in 150 patients with and without intake of antiplatelets (p = 0.024).
Mentions: The rHU was significantly lower for a HAS located in the M1 segment compared to a distal occlusion (p = 0.019). rHU was higher in patients on antiplatelets prior to stroke (p = 0.024, Figure 1). In contrast, this could not be shown for the patients receiving anticoagulants (n = 18). This finding was pronounced in the analysis of M2 occlusions (p = 0.021), whereas no impact of prior antiplatelet usage was found in thrombi occluding the M1 segment (p = 0.419). The erythrocyte count was negatively correlated with rHU (p < 0.001, rho = −0.324). We did not identify an association of fibrinogen levels with rHU. The thrombocyte count was negatively related to rHU in the M2 segment only (p = 0.05, rho = −0.626). We did not find differences of rHU by TOAST etiology, or by cardioembolic vs. other etiologies. Area and length of the thrombus did not correlate with the rHU. This finding was corroborated in patients with cardioembolic vs. other etiologies. In a subgroup of patients that underwent mechanical thrombectomy, there was no correlation with length, area, or history of antiplatelets with recanalization.

View Article: PubMed Central - PubMed

ABSTRACT

We explored whether clot density in middle cerebral artery (MCA) occlusion is related to clinical variables, stroke etiology, blood constituents, and prestroke medication. We performed a retrospective chart review of patients with acute ischemic stroke of the anterior circulation admitted to two Central European stroke centers. The acquisition of non-contrast enhanced CT (NECT) and CT angiography (CTA) within 4.5 h of symptom onset was obligatory. We assessed the site of MCA occlusion as well as density, area, and length of the clot in 150 patients. The Hounsfield unit values for the clot were divided with contralateral MCA segment to yield relative Hounsfield Unit ratio (rHU). The site of the vessel occlusion (M1 vs. M2) and antiplatelet usage, but not stroke etiology, significantly influenced rHU. We found an inverse correlation of rHU with erythrocyte count (p &lt; 0.001). The multivariate analysis revealed that a higher rHU (i.e., clot being more hyperdense) was more likely with the use of antiplatelets (OR 4.24, CI 1.10&ndash;16.31, p = 0.036). Erythrocyte (OR 0.18, CI 0.05&ndash;0.55, p = 0.003), and thrombocyte counts (OR 0.99, CI 0.98&ndash;0.99, p = 0.029) were associated with odds for more hypodense clots (lower rHU). Our study disclosed that antiplatelet therapy impacts the composition of intracranial clots of the anterior circulation.

No MeSH data available.