High-resolution magnetic resonance imaging of acute intracranial artery thrombus

Eur J Neurol. 2023 Oct;30(10):3172-3181. doi: 10.1111/ene.15985. Epub 2023 Aug 7.

Abstract

Background and purpose: The development of high-resolution magnetic resonance imaging (HR-MRI) has enabled submillimeter-level evaluation of intracranial artery plaque and luminal thrombus. We sought to investigate the value of HR-MRI in assessing the pathogenesis of acute intracranial artery thrombus.

Methods: We examined the presence of intracranial thrombus on three-dimensional T1-weighted HR-MRI in acute ischemic stroke patients with intracranial artery occlusion on magnetic resonance angiography. We defined two thrombus-related HR-MRI features (peri-thrombus plaque and distal residual flow beyond the thrombus) and analyzed their association with potential embolic sources.

Results: Luminal thrombus and a shrunken artery without luminal thrombus were detected in 162 (96.4%) and six (3.6%) of 168 patients with intracranial artery occlusion, respectively. Among 111 patients with culprit major artery thrombus, peri-thrombus plaques were observed in 46.8% and distal residual flow beyond the thrombus in 64.0%. Patients with peri-thrombus plaque had a higher prevalence of diabetes (44.2% vs. 25.4%; p = 0.037), a lower prevalence of potential sources of cardioembolism (0% vs. 16.9%; p = 0.002), and a nonsignificantly lower prevalence of potential embolic sources from extracranial arteries (9.6% vs. 20.3%; p = 0.186) than those without. Patients with distal residual flow beyond the thrombus had a lower prevalence of potential sources of cardioembolism (1.4% vs. 22.5%; p < 0.001) and smaller infarct volumes (5.0 [1.4-12.7] mL vs. 16.6 [2.4-94.6] mL; p = 0.012) than those without.

Conclusions: Our study showed that HR-MRI helps clarify the pathogenesis of acute intracranial artery thrombus. The presence of peri-thrombus plaque and distal residual flow beyond the thrombus favor the stroke mechanism of atherosclerosis rather than cardioembolism.

Trial registration: ClinicalTrials.gov NCT02485275.

Keywords: cardioembolism; high-resolution magnetic resonance imaging; intracranial atherosclerosis; intracranial thrombus; plaque.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Arteries / pathology
  • Humans
  • Intracranial Arteriosclerosis* / complications
  • Intracranial Arteriosclerosis* / diagnostic imaging
  • Intracranial Thrombosis* / complications
  • Intracranial Thrombosis* / diagnostic imaging
  • Ischemic Stroke* / complications
  • Magnetic Resonance Angiography / adverse effects
  • Magnetic Resonance Angiography / methods
  • Magnetic Resonance Imaging / methods
  • Plaque, Atherosclerotic* / complications
  • Plaque, Atherosclerotic* / diagnostic imaging
  • Stroke* / complications
  • Stroke* / etiology
  • Thrombosis* / diagnostic imaging

Associated data

  • ClinicalTrials.gov/NCT02485275