BACKGROUND AND PURPOSE To evaluate whether the thrombus enhancement sign (TES) can be used to differentiate embolic large vessel occlusion (LVO) from in situ intracranial atherosclerotic stenosis (ICAS)-related LVO in the anterior circulation of patients with acute ischemic stroke (AIS). METHODS Patients with LVO in the anterior circulation who underwent both non-contrast computed tomography (CT) and CT angiography and mechanical thrombectomy were retrospectively enrolled. Both embolic LVO (embo-LVO) and in situ ICAS-related LVO (ICAS-LVO) were confirmed by two neurointerventional radiologists after reviewing the medical and imaging data. TES was assessed to predict embo-LVO or ICAS-LVO. The associations between occlusion type and TES, along with clinical and interventional parameters, were investigated using logistic regression analysis and a receiver operating characteristic curve. RESULTS A total of 288 patients with AIS were included and divided into an embo-LVO group (n=235) and an ICAS-LVO group (n=53). TES was identified in 205 (71.2%) patients and was more frequently observed in those with embo-LVO, with a sensitivity of 83.8%, specificity of 84.9%, and area under the curve (AUC) of 0.844. Multivariate analysis showed that TES (odds ratio [OR], 22.2; 95% confidence interval [CI], 9.4-53.8; P<0.001) and atrial fibrillation (OR, 6.6; 95% CI, 2.8-15.8; P<0.001) were independent predictors of embolic occlusion. A predictive model that included both TES and atrial fibrillation yielded a higher diagnostic ability for embo-LVO, with an AUC of 0.899. CONCLUSION TES is an imaging marker with high predictive value for identifying embo- and ICAS-LVO in AIS and provides guidance for endovascular reperfusion therapy.

中文翻译：

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血栓增强标志可区分栓塞与动脉硬化相关的大血管闭塞。

背景和目的 评估血栓增强征 (TES) 是否可用于区分急性缺血性卒中 (AIS) 患者前循环中的栓塞性大血管闭塞 (LVO) 与原位颅内动脉粥样硬化性狭窄 (ICAS) 相关的 LVO . 方法 回顾性纳入接受非对比计算机断层扫描 (CT) 和 CT 血管造影以及机械血栓切除术的前循环 LVO 患者。栓塞性 LVO (embo-LVO) 和原位 ICAS 相关 LVO (ICAS-LVO) 均由两位神经介入放射科医师在审查医学和影像数据后确认。评估 TES 以预测 embo-LVO 或 ICAS-LVO。闭塞类型和 TES 之间的关联，以及临床和介入参数，使用逻辑回归分析和接受者操作特征曲线进行调查。结果 共纳入 288 例 AIS 患者，分为 embo-LVO 组（n=235）和 ICAS-LVO 组（n=53）。TES 在 205 名 (71.2%) 患者中被识别出来，并且在有 embo-LVO 的患者中更常见，灵敏度为 83.8%，特异性为 84.9%，曲线下面积 (AUC) 为 0.844。多变量分析显示 TES（比值比 [OR]，22.2；95% 置信区间 [CI]，9.4-53.8；P<0.001）和房颤（OR，6.6；95% CI，2.8-15.8；P<0.001）是栓塞闭塞的独立预测因子。包括 TES 和心房颤动的预测模型对 embo-LVO 具有更高的诊断能力，AUC 为 0.899。