Thrombus Composition, Imaging, and Outcome Prediction in Acute Ischemic Stroke.

Background and Objectives New imaging techniques have advanced our ability to capture thrombus characteristics and burden in real time. An improved understanding of recanalization rates with thrombolysis and endovascular thrombectomy based on thrombus characteristics has spurred interest in new therapies for acute stroke. Methods and Results This article reviews the biochemical, structural, and imaging characteristics of intracranial thrombi in acute ischemic stroke; the relationship between thrombus composition and response to lytic and endovascular therapies; and current and future directions for improving outcomes in patients with acute stroke based on thrombus characteristics. Discussion Thrombus composition, size, location, and timing from stroke onset correlate with imaging findings in acute ischemic stroke and are associated with clinical outcome. Further research across multiple domains could assist in better applying our knowledge of thrombi to patient selection and individualization of acute therapies.