Intraluminal Thrombus of the Extracranial Cerebral Arteries in Acute Ischemic Stroke: Manifestations, Treatment Strategies, and Outcome

Figures & data

Table 1 Patients’ Baseline Characteristics and Associated Comorbid Conditions

	N (%)
Age
≥60 years	17 (60.7)
<60 years	11 (39.2)
Gender
Male	16 (57.1)
Female	12 (42.9)
BMI
Underweight	1 (3.5)
Normal	7 (25)
Overweight	12 (42.8)
Obese	8 (28.5)
Smoking Status
Smoker	4 (14.3)
Non-smoker	24 (85.7)
Comorbid Conditions
Hypertension	17 (60.7)
Diabetes Mellitus	16 (57.1)
Transient Ischemic Attack/Stroke	11 (39.3)
Patent Foramen Ovale	5 (17.9)
Cancer	4 (14.3)
Dyslipidemia	4 (14.3)
Chronic Kidney Disease	2 (7.1)
Heart Failure	1 (3.6)
Coronary Artery Disease	1 (3.6)
Peripheral Arterial Disease	1 (3.6)
Arterial Involvement
Internal Carotid Artery	22 (87.6)
Aortic Arch	2 (7.1)
Vertebral Artery	1 (3.6)
Internal Carotid Artery and Aortic Arch	1 (3.6)
Brachiocephalic Artery	1 (3.6)
Subclavian Artery	1 (3.6)
Causes of Stroke
Atherosclerosis	18 (64.3)
Cardioembolic cause	4 (14.3)
Dissection/Suspected Dissection	2 (7.1)
Unknown	3 (10.7)
Embolic source of determined source	1 (3.6)
Time From Symptoms Onset to Presentation
<12 Hours	17 (60.7)
12–24 Hours	4 (14.3)
25–48 Hours	4 (14.3)
>48 Hours	3 (10.7)
Length of Hospitalization
< 7 Days	8 (28.5)
7–14 Days	13 (46.4)
15–21 Days	4 (14.2)
> 21 Days	3 (10.7)
Complications
Intensive Care Unit Admission	5 (17.5)
Mechanical Ventilation	1 (3.5)
Mortality*	1 (3.5)

Note: *The only death was a 60-year-old male smoker who had cancer and diabetes and had a stroke due to an embolic stroke of undetermined source.

Table 2 The Presenting Signs and Symptoms of the Studied Sample

	N (%)
Unilateral Limb Weakness	23 (82.1)
Dysarthria	13 (46.4)
Facial Weakness	7(25)
Dysphasia/Mutism	3(10.7)
Hemianopia/Quadrantanopia/Field defect	3(10.7)
Vertigo/Incoordination/Dizziness	3(10.7)
Vision Changes Other Than Anopia	3(10.7)
Unresponsiveness/Low GSC	3(10.7)
Sensory Deficit	2(7.1)
Seizure	1(3.5)
Headache	1(3.5)

Figure 1 Distribution of intraluminal thrombus in the extracranial arteries. The most common location of ILT was ICA followed by the aortic arch. Reproduced with permission from Yazan Alghammas as this figure has been drawn specifically for this research project.

Table 3 Treatment Offered to the Patients at Different Time Intervals

	Initial Treatment, N (%)	Short-Term Treatment, N (%)	Long-Term Treatment, N (%)*
Anti-platelets	4 (14.3)	8 (27.6)	14 (50.0)
Single Agent	0 (0)	3 (10.7)	9 (32.1)
TPA followed by Single Agent	1 (3.6)	0 (0)	0 (0)
Dual Agents	3 (10.7)	5 (17.6)	5 (17.9)
Anti-coagulants	24 (85.7)	20 (71.4)	12 (42.9)
Heparin	22 (78.6)	7 (25.0)	1 (3.6)
TPA followed by Heparin	2 (7.1)	0 (0)	0 (0)
Warfarin	0 (0)	8 (28.6)	5 (17.9)
DOAC	0 (0)	5 (17.9)	6 (21.4)

Note: *2 (7.14%) patients did not receive long-term treatment.

Table 4 Safety Outcomes Based on Treatment Group

Readmission with Stroke/TIA
	N	%	Initial treatment	Short-Term treatment	Long-Term Treatment	Artery	Etiology
Within 3 Months	3	10.71%	Patient 1 Heparin Patient 2 Heparin Patient 3 Heparin	Patient 1: warfarin Patient 2: warfarin Patient 3: warfarin	Patient 1: SAPT Patient 2: SAPT Patient 3: DAPT	ICA ICA Aortic arch	Atherosclerosis Atherosclerosis Atherosclerosis
> 3 Months	1	3.57	Patient 4 Heparin + TPA	Patient 4: warfarin	Patient 4: SAPT	ICA	Cardioembolic

Table 5 Efficacy Outcomes Based on NIHSS at Different Time Intervals

NIHSS Score	At Presentation	At Day 7	P Value
Anti-coagulant (N=24)	7.2±5.4	5.8±4.7	0.059
Anti-platelets (N=4)	11.3±7.8	14.0±0	0.017
NIHSS score	At presentation	At day 90	P value
Anti-coagulant (N=24)	7.2±5.4	4.0±4.3	0.011
Anti-platelets (N=4)	11.3±7.8	7.3±7.3	0.317

Table 6 Efficacy Outcomes Based on Follow-Up Repeat Scans

	Partial Resolution (N= 3)	Complete Resolution (N= 18)	Worsen (N= 1)	Not Changed (N =2)
Anti-platelets (N= 3)	None	100% (N= 3)	None	None
Anti-coagulants (21)	12% (N= 3)	71.43% (N= 15)	4.7% (N= 1)	9.5% (N= 2)

Figure 2 (A and B) computed tomography angiography of 51 years old female with ILT of ICA. (C and D) Follow-up computed tomography angiography of the same patient within 3 months shows complete resolution of the thrombus after starting medical treatments.