AUTHOR=Kufner Anna , Endres Matthias , Scheel Michael , Leithner Christoph , Nolte Christian H. , Schlemm Ludwig 

TITLE=No Association Between Thrombus Perviousness and Cardioembolic Stroke Etiology in Basilar Artery Occlusion Stroke

JOURNAL=Frontiers in Neurology

VOLUME=Volume 12 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.712449

DOI=10.3389/fneur.2021.712449

ISSN=1664-2295

ABSTRACT=Background 
Thrombus perviousness (TP) quantified by thrombus attenuation increase (TAI) assessed on acute non-contrast computed tomography (NCCT) and CT-angiography (CTA) may be associated with stroke etiology in anterior circulation ischemic stroke. We investigated whether TP is associated with stroke etiology and recanalization after mechanical thrombectomy in patients acute basilar artery occlusion (BAO).
Methods
Eighty patients with complete BAO and in-house acute imaging from a prospectively maintained database were included. Two raters independently segmented the complete thrombus on co-registered NCCT and CTA to determine TAI in Hounsfield units (HUCTA – HUNCCT); averaged values of the raters were used for analysis. Recanalization to mTICI 2b/3 was considered successful, 90-day modified Rankin Score 0-2 was considered favorable. 
Results
TAI did not differ between patients with different stroke etiologies; median TAI in patients with cardioembolic stroke (n=36) was -0.47 (interquartile range -4.08 to 7.72), 1.94 (-8.14 to 10.75) in patients with large-artery atherosclerosis (LAA, n=25), and -0.99 (-6.49 to 5.40) in patients with stroke of undetermined origin (n=17; p=0.955). Binary logistic regression analyses did not identify TAI as an independent indicator of cardioembolic stroke (adjusted OR versus LAA stroke: 1.0 [95CI 0.95-1.0], p=0.751). There was no association with successful recanalization (adjusted OR 1.4 [0.70-2.7], p=0.345) or outcome (adjusted OR 1.1 [95% CI 0.94-1.2], p=0.304).
Conclusion
In contrast to proximal middle cerebral artery occlusions, TP in BAO patients is not associated with cardioembolic stroke etiology. Larger confirmatory studies to establish the potential role of TP for clinical applications should focus on patients with anterior circulation stroke.