AUTHOR=Li Jichuan , Yang Jianhong , Gao Xiang , Han Qing , Wu Yuefei , Shang Qing , Huang Yueshi , Xu Yao , Huang Yi , Lin Longting 

TITLE=Clot patterns determined by DSA and CTA can help predict intracranial atherosclerotic stenosis in acute ischemic stroke patients

JOURNAL=Frontiers in Neurology

VOLUME=Volume 15 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2024.1395764

DOI=10.3389/fneur.2024.1395764

ISSN=1664-2295

ABSTRACT=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.