Noninvasive Thrombus Imaging in Patients With Ischemic Stroke.
GP1 uptake is associated with a 10.4-fold higher risk of recurrent stroke or TIA.
Noninvasive Thrombus Imaging in Patients With Ischemic Stroke.
Determining the source of thromboembolism in patients with acute ischemic stroke remains challenging because current diagnostic approaches rely largely on circumstantial and inferential associations rather than direct identification of the cause of stroke.
We aimed to determine whether hybrid [ 18 F]GP1 positron emission tomography (positron emission tomography) and computed tomography angiography could identify in vivo cardiovascular thromboembolism in patients with acute ischemic stroke and provide a mechanism-based assessment of stroke etiology.
In a single-center prospective observational cohort study, 100 patients presenting with acute ischemic stroke underwent hybrid [ 18 F]GP1 positron emission tomography/computed tomography angiography within 21 days of symptom onset in addition to standard-of-care stroke investigations.
Cardiovascular [ 18 F]GP1 uptake indicative of thrombosis was identified in nearly two-thirds (n=63) of participants, changing stroke classification in over a quarter (n=26) of patients.
In those with stroke of undetermined cause, the source of thrombus was identified in 18 of 41 (44%) participants, which included nonstenotic carotid atherothrombosis, native cardiac valve thrombosis, and paradoxical thromboembolism.
Noninvasive thrombosis imaging is a novel technique that enables direct in vivo identification of thrombus formation and frequently reveals the source of thromboembolism in patients with acute ischemic stroke.
This approach represents a shift from inference-based to mechanism-based stroke classification with potential implications for targeted prevention strategies and better patient outcomes.