Circulation
September 1, 2026 · via Europe PMC
Noninvasive Thrombus Imaging in Patients With Ischemic Stroke.
Whittington B, Balmforth C, Giaj Levra A, +26 more, Newby DE.
AI summary — for doctors, generated from the abstract only
PET imaging of activated platelets found thrombus in nearly two-thirds of acute ischemic stroke patients and often revealed a stroke source.
What was studied
Single-center prospective cohort of 100 acute ischemic stroke patients who had [18F]GP1 PET/CT angiography within 21 days, with stroke etiology classified by a blinded stroke physician.
Key findings
- Cardiovascular uptake was found in 63 patients and changed stroke classification in 26.
- In strokes of undetermined cause, a thrombus source was identified in 18 of 41 (44%).
- Recurrent stroke or TIA occurred in 14 patients, 13 of whom had baseline uptake (HR 10.4; 95% CI 1.35-79.40).
Clinical relevance
It might make etiologic stroke workup more mechanism-based and guide prevention.
Who should care
Limitations
This is a single-center, 100-patient study with a wide confidence interval, and the tracer is investigational.
Not yet available for routine use; await larger studies and tracer access.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
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. Fluorine-18 GP1 ([18F]GP1) is a novel radiotracer that binds with high affinity and specificity to activated glycoprotein IIb/IIIa receptors on activated platelets. We aimed to determine whether hybrid [18F]GP1 positron emission tomography (PET) 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.
Methods
In a single-center prospective observational cohort study, 100 patients presenting with acute ischemic stroke underwent hybrid [18F]GP1 PET/computed tomography angiography within 21 days of symptom onset in addition to standard-of-care stroke investigations. Stroke etiology was classified using the causative classification system by an expert stroke physician blinded to [18F]GP1 PET findings. In parallel, [18F]GP1 PET/computed tomography angiography images were analyzed independently by readers who were blinded to all clinical data and causative classification system classification. We assessed whether [18F]GP1 PET/computed tomography angiography could identify the source of in vivo cardiovascular thromboembolism, influence stroke classification, and predict recurrent cerebrovascular events.
Results
Cardiovascular [18F]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. During a median follow-up of 613 (interquartile interval, 251-788) days, recurrent stroke or transient ischemic attack occurred in 14 patients, 13 (93%) of whom had cardiovascular [18F]GP1 uptake at baseline. Cardiovascular [18F]GP1 uptake was associated with a 10.4-fold increased risk of recurrent events (95% CI, 1.35-79.40; P=0.024).
Conclusions
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.
Registration
URL: https://www.clinicaltrials.gov; Unique Identifier: NCT05636748.
DOI
10.1161/circulationaha.126.080420
PMID
42677492
PMCID
PMC13668038
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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