Deans' stroke musings: Higher fibrinogen levels contributes to thrombosis in intracranial atherosclerosis-related large vessel occlusion strokes

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, March 9, 2026

Higher fibrinogen levels contributes to thrombosis in intracranial atherosclerosis-related large vessel occlusion strokes

You described a problem, but uselessly did nothing to prevent it! You're fired!

Higher fibrinogen levels contributes to thrombosis in intracranial atherosclerosis-related large vessel occlusion strokes

Y
Yimeng Liu 1†
Hongchen Zhao 1†
Yifeng Ling 1
F
Fangzhe Chen 1
Zigao Wang 1
Yiting Mao 1
Q
Qiang Dong 1,2,3*
Wenjie Cao 1,2,3*

1. Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
2. State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China

Abstract

Background:

The mechanisms underlying large-vessel occlusion strokes (LVOS) caused by intracranial atherosclerosis (ICAS) remain incompletely understood. This study aimed to characterize the distinct features of ICAS-LVOS to elucidate its pathological basis.

Methods:

We conducted a cross-sectional analysis of a prospective, single-center cohort of acute ischemic stroke patients (January 2017 to January 2023). Participants were classified into three groups: ICAS-LVOS, atrial fibrillation-related LVOS (AF-LVOS), and symptomatic ICAS without LVOS (sICAS). Clinical and laboratory data were compared.

Results:

The study included 279 patients, comprising 70 ICAS-LVOS patients, 78 AF-LVOS patients, and 131 sICAS patients. Compared to AF-LVOS, ICAS-LVOS patients demonstrated associations with younger age (OR: 0.898; p = 0.007), previous stroke (OR: 6.672; p = 0.031), posterior circulation involvement (OR: 30.299; p = 0.011) and higher fibrinogen levels (OR: 3.421; p = 0.006). A ratio of fibrinogen/D-dimer ≥6 effectively identified ICAS-LVOS with high specificity. Relative to sICAS, ICAS-LVOS was associated with higher body mass index (OR: 1.176; p = 0.002), white blood cell counts (OR: 1.234; p = 0.002), and fibrinogen levels (OR: 1.600; p = 0.029). Within the ICAS-LVOS group, higher thrombus burden was correlated with hypertension (OR: 6.071; p = 0.029) and higher fibrinogen levels (OR: 2.322; p = 0.046). Notably, in patients with fibrinogen levels <3.2 g/L, intravenous thrombolysis was associated with fewer passes of thrombectomy devices.

Conclusion:

ICAS-LVOS exhibits a unique profile distinct from AF-LVOS and sICAS. Fibrinogen appears to play a significant role in thrombogenesis and the occurrence of LVOS in ICAS, influencing thrombus characteristics and potentially modifying the efficacy of thrombolysis in specific patient subgroups.

Highlights

What is already known: The specific mechanisms by which intracranial atherosclerosis (ICAS) leads to large-vessel occlusion stroke (LVOS) remain poorly defined, unlike the well-established causes of cardioembolic stroke.
What this study adds: We identify that ICAS-LVOS has a distinct profile, including younger age and higher fibrinogen levels. A fibrinogen/D-dimer ratio ≥6 helps identify it, and fibrinogen is linked to both its occurrence and a heavier thrombus burden.
How this study might affect research, practice or policy: Fibrinogen could be a future therapeutic target, and the fibrinogen/D-dimer ratio may aid in early etiology diagnosis, potentially guiding acute treatment decisions.