engleski

Antiplatelet usage alters clot density in acute ischemic stroke: A hyperdense middle cerebral artery study

Background and aims: The hyperdense artery sign on computed tomography is a surrogate of intraluminal thrombus. Clot density can be quantified by means of Hounsfield Units (HU). Here, we explored whether clot density in middle cerebral artery (MCA) occlusion is related to blood constituents and prestroke medication. Methods: We performed a retrospective review of patients with ischemic stroke admitted within 4.5 h of symptom onset. We assessed the site of MCA occlusion as well as density of the clot in 150 patients. The HU values for the clot were divided with contralateral MCA segment to yield relative HU ratio (rHU). Results: We found an inverse correlation of rHU with erythrocyte count (p<0.001). Patients on antiplatelets had a significantly higher rHU compared to patients without (p=0.024). Higher rHU 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. Conclusion: Aspirin alters clot structure in vitro, resulting in the formation of clots with thicker fibbers and bigger pores, which subsequently allows better entanglement of erythrocytes and raises the efficacy of thrombolysis. Our study disclosed an effect of antiplatelet therapy on the composition of intracranial clots in the setting of acute ischemic stroke in the anterior circulation. This finding may in part explain the higher success of thrombolyis and better prognosis ischemic stroke in patients on aspirin.Disclosure: Nothing to disclose

ischemic stroke, hyperdense artery sign, antiplatelets, computed tomography, clot

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