Abstract

Motivation: Mechanical thrombectomy (MT) is the standard for ischemic stroke with large vessel occlusion (LVO). Clot composition is underexplored in clinical practice, leading to standardized MT regardless of clot type. Goal(s): This single-center study examined clot composition in 60 LVO stroke patients using high-field MRI at 9.4T ("MR-microscopy"). Approach: MR microscopy correlated with histopathology, and quantifying the hyperdense artery sign (HAS) on pre-interventional CT further stratified clot composition. Results: MR microscopy successfully identified clot types—red (23%), white (28%), or mixed (48%)—with 95.4% accuracy. White clots required more passes during MT, had worse clinical outcomes, while red clots showed better first-pass recanalization rates. Impact: This study suggests clot imaging can personalize MT for improved outcomes in LVO stroke patients.