When void matters: Imaging, detection, quantification, and analysis of thrombi in patients with acute ischemic stroke

Stroke is the most common cause of disability and the third most common cause of death worldwide. However, despite improvements in imaging techniques and treatments, there is a large group of patients that do not recover with currently available therapies. Ischemic stroke, which accounts for 80% of all strokes, is caused by a thrombus that occludes an intracranial artery. The work in this thesis is based on the hypothesis that imaging characteristics of the occluding thrombus may be useful to predict outcomes and guide treatment selection. We showed that assessments of thrombus imaging characteristics (including volume and penetration of contrast agent through the thrombus) using automated image processing techniques have great prognostic value. Furthermore, we brought evidence that these characteristics could support treatment selection in acute care because they are strongly related with treatment efficacy. Automated analysis of thrombus characteristics on admission is likely to help physicians to evaluate - in a tailored way - the risks and benefits of currently available treatment for a particular patient, thus improving clinical outcome of all acute ischemic strokes.